Keywords
program hemodialysis
cognitive disorders
polyneuropathy
restless legs syndrome
hyperparathyroidism
serum iron
Abstract
Introduction. Chronic kidney disease (ChKD), program hemodialysis (PHD) are associated with a high risk of neurological complications that significantly impair patients' quality of life.
The aim of the work is to identify the spectrum of neurological complications in patients with end-stage CKD receiving adequate PHD (eKt/V >1.2), establish their relationship with hemodialysis duration and factors influencing their development.
Materials and methods. 50 patients receiving PHD were examined. Two groups were identified: I — with dialysis experience <10 years (n = 35); II — with dialysis experience of 10 years or more (n = 15). To determine the severity of cognitive was used MoCA test; the degree of neuropathic pain — painDETECT; for Restless Legs Syndrome (RLS) — International RLS Severity Scale. History was studied, neurological examination was performed, laboratory data (hemoglobin, serum iron, calcium, phosphorus, parathormone, C-reactive protein (CRP) and instrumental examination — surface stimulation electromyography were analyzed. A correlation was made between indicators of the applied scales and possible risk factors.
Results and discussion. All patients with end-stage CKD on PGD showed cognitive impairment, pain neuropathic syndrome and RLS, which significantly prevailed in severity in patients of group II. Statistically significant correlations were found between the severity of cognitive disorders and sensory polyneuropathy with secondary hyperparathyroidism, which is associated with impaired phosphorus-calcium metabolism. A correlation was established between the severity of sensory polyneuropathy with the level of CRP, and the severity of RLS with a low level of serum iron. In patients of group II the correlation with similar indicators was more significant.
Conclusions. Neurological complications are associated with the severity of CKD, duration of PGD, metabolic disorders. For the prevention of cognitive disorders and neuropathy it should be recommended to correct phosphorus-calcium metabolism; for the prevention of RLS — erythropoietin and iron preparations; to increase the clearance of uremic toxins — dialysis optimization.
For citation
Remennaya AD, Nadezhdina MV. Neurological complications in patients with chronic kidney disease receiving renal replacement therapy by program hemodialysis. USMU Medical Bulletin. 2025;10(4):e00191. (In Russ.). DOI: https://doi.org/10.52420/usmumb.10.4.e00191. EDN: https://elibrary.ru/HZITXP.
References
Национальная ассоциация нефрологов. Хроническая болезнь почек: клинические рекомендации М-ва здравоохранения РФ. Москва; 2024. [National Association of Nephrologists. Chronic kidney disease: Clinical recommendations of the Ministry of Health of the Russian Federation. Moscow; 2024. (In Russ.)]. Available from: https://clck.ru/3QCRrK (accessed 7 October 2025).
Даугирдас ДТ, Блейк ПГ, Инг ТС (ред.); Земченков АЮ, Шило ВЮ (ред. пер. на рус.). Руководство по диализу. 5-е изд. Тверь: Триада; 2018. XX, 747 с. [Daugirdas JT, Blake PG, Ing TS (eds.); Zemchenkov AY, Shilo VY (Russ. transl. eds.). Handbook of dialysis. 5th. Tver: Triada; 2018. XX, 747 p. (In Russ.).].
Синюхин ВН, Рабинович ЭЗ, Соколов МА, Сивков АВ. Неврологические расстройства при хронической болезни почек. Экспериментальная и клиническая урология. 2017;(2):92–101. [Sinyukhin VN, Rabinovich EZ, Sokolov MA, Sivkov AV. Neurological disorders in chronic kidney disease. Experimental and Clinical Urology. 2017;(2):92–101. (In Russ.)]. EDN: https://elibrary.ru/ZEHPPD.
Krishnan AV, Kiernan MC. Neurological complications of chronic kidney disease. Nature Reviews Neurology. 2009;5(10):542–551. DOI: https://doi.org/10.1038/nrneurol.2009.138.
Drew DA, Weiner DE, Tighiouart H, Scott T, Lou K, Kantor A, et al. Cognitive function and all-cause mortality in maintenance hemodialysis patients. American Journal of Kidney Diseases. 2015;65(2):303–311. DOI: https://doi.org/10.1053/j.ajkd.2014.07.009.
Милованова ЛЮ, Милованов ЮС, Козловская ЛВ. Нарушения фосфорно-кальциевого обмена при хронической болезни почек III–V стадий. Клиническая нефрология. 2011;(1):58–68. [Milovanova LY, Milovanov YS, Kozlovskaya LV. Disorders of phosphorus-calcium metabolism in chronic kidney disease of stages III–V. Clinical Nephrology. 2011;(1):58–68. (In Russ.)]. EDN: https://elibrary.ru/NEVBMX.
Wang L, Jerosch-Herold M, Jacobs DR, Shahar E, Detrano R, Folsom AR. Coronary artery calcification and myocardial perfusion in asymptomatic adults: The MESA (Multi-Ethnic Study of Atherosclerosis). Journal of the American College of Cardiology. 2006;48(5):1018–1026. DOI: https://doi.org/10.1016/j.jacc.2006.04.089.
Nishimura M, Tsukamoto K, Tamaki N, Kikuchi K, Iwamoto N, Ono T. Risk stratification for cardiac death in hemodialysis patients without obstructive coronary artery disease. Kidney International. 2011;79(3):363–371. DOI: https://doi.org/10.1038/ki.2010.392.
Милованова ЛЮ, Николаев АЮ, Милованов ЮС. Гиперфосфатемия как фактор риска сердечно-сосудистых заболеваний у больных ХПН на хроническом гемодиализе. Нефрология и диализ. 2002;4(2):113–117. [Milovanova LY, Nikolaev AY, Milovanov YS. Hyperphosphatemia as a risk factor for cardiovascular diseases in patients with chronic renal failure on chronic hemodialysis. Nephrology and Dialysis. 2002;4(2):113–117. (In Russ.)]. Available from: https://clck.ru/3QCTau (accessed 7 October 2025).
Zhu XY, Wu TT, Wang HM, Li X, Ni LY, Chen TJ, et al. Correlates of nonanemic iron deficiency in restless legs syndrome. Frontiers in Neurology. 2020;11:298. DOI: https://doi.org/10.3389/fneur.2020.00298.
Youdim MBH, Ben-Shachar D, Yehuda S. Putative biological mechanisms of the effect of iron deficiency on brain biochemistry and behavior. The American Journal of Clinical Nutrition. 1989;50(3):607–617. DOI: https://doi.org/10.1093/ajcn/50.3.607.
Trotti LM, Becker LA. Iron for the treatment of restless legs syndrome. Cochrane Database of Systematic Reviews. 2019;(1):CD007834. DOI: https://doi.org/10.1002/14651858.CD007834.pub3.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
Copyright © 2025 Remennaya A. D., Nadezhdina M. V.