NEUROMUSCULAR FUNCTION IN PEOPLE WITH CHRONIC KIDNEY DISEASE ON HEMODIALYSIS INITIATION

Abstract

Background

The progression of chronic kidney disease (CKD) to its most advanced stage, which usually requires hemodialysis, causes metabolic changes that can impact the neuromuscular system of this population. The difficulty of early detection of CKD often leads to late nephrological referral and initiation of hemodialysis on an emergency basis.

Objectives

To assess neuromuscular function in people with CKD starting hemodialysis.

Methods

Cross-sectional study, evaluating the neuromuscular function in people with CKD admitted to an urgent and emergency hospital who started hemodialysis on an emergency basis (CKD group) compared to people without kidney disease (control group). Measures of neuromuscular excitability (chronaxie obtained in the stimulus electrodiagnostic test), peripheral muscle strength (peak strength focused on lower limb isometric dynamometry) and functional capacity (number of repetitions in the 1-minute sit-to-stand test) were used. To compare the results between the groups, Student's t test was used for variables with normal distribution and the Mann-Whitney test for variables with non-normal distribution, adopting a rejection index of the null hypothesis ≤ 0.05.

Results

Twenty-eight participants, 14 without kidney disease (42 ± 12 years, 5 males and 9 females) and 14 in the CKD group (53 ± 18 years, 9 males and 5 females) were evaluated. The CKD group, compared to controls without kidney disease, showed impairment in neuromuscular excitability (vastus lateralis chronaxie: 654 ± 230 vs 415 ± 190 μs, p = 0.008; tibialis anterior chronaxie: 600 [500 - 1000] vs 400 [300 - 400] μs, p = 0.001), peripheral muscle strength in all muscles assessed (knee extensors: 12. 3 ± 4.6 vs 23.5 ± 9 kgf; knee flexors: 11.3 ± 3.2 vs 17.8 ± 4.3 kgf; dorsiflexors: 8.7 ± 2.8 vs 16.7 ± 4.3 kgf; and plantar flexors: 11.2 ± 2.5 vs 16.6 ± 4.4 kgf, all p < 0.001) and in functional capacity (13.8 ± 4.9 vs 36.7 ± 9.1 repetitions, p < 0.001).

Conclusion

People with advanced CKD who started hemodialysis on an emergency basis have impaired neuromuscular function, considering neuromuscular excitability, lower limb isometric muscle strength and functional capacity.

Implications

These findings may guide screening and monitoring strategies for neuromuscular deficiencies and rehabilitation planning.