Chronic Kidney Disease and Neuropathy

Neuropathy is a condition that causes damage to the nerves. Nerves are found throughout the body. They are responsible for sending chemical signals between the brain, spinal cord, and the rest of the body. People who have chronic kidney disease (CKD) are more likely to develop neuropathy than people who do not have the condition.^1-4

Types of neuropathies

Different types of neuropathies affect nerves from different areas of the body. The four main types of neuropathies are:^1-3

• Peripheral neuropathy – This type of neuropathy affects nerves that connect the spinal cord to your arms, legs, hands, and feet. This is the most common type of neuropathy among people with CKD.
• Focal neuropathy – This type of neuropathy affects only a single nerve. The affected nerve can be anywhere in the body, such as in the chest or in an arm or leg.
• Autonomic neuropathy – This type of neuropathy affects the nerves that are responsible for doing things that happen automatically, such as beating of the heart or digesting food.
• Proximal neuropathy – This type of neuropathy starts in the hips and can affect nerves in the upper thighs and lower back.

What causes neuropathy?

Certain risk factors can make it more likely for neuropathy to occur. These include:^1,2

• High blood sugar
• High lipid levels, such as high cholesterol
• High blood pressure
• Inflammation or swelling
• Older age
• Unhealthy lifestyle habits such as poor diet and smoking

Some diseases also can increase the risk of developing neuropathy. Since diabetes can lead to high blood sugar levels, it is a common risk factor for neuropathy. People who have both CKD and diabetes are at even higher risk.^2,3,5

Studies show that as kidney function gets worse, the risk for developing neuropathy goes up. Factors related to CKD that can increase the risk for neuropathy include:^2,3,5

• Dialysis – People on dialysis are at higher risk for neuropathy.
• Uremic toxins – These are harmful compounds or toxins that can start to build up in the body during kidney failure. They can cause nerve damage and thus neuropathy.
• Calcification – When kidneys are not working normally, too much calcium can start to build up in the body. This buildup can damage the nerves.
• High potassium levels – In people with CKD, the amount of potassium in the blood can become too high. Too much potassium can lead to nerve damage.

Symptoms of neuropathy

Symptoms of neuropathy can include:^1,3

• Pain
• Burning or tingling in the hands or feet
• Loss of feeling in the affected area
• Muscle weakness
• Numbness or paralysis
• Problems with your hearing or vision
• Trouble walking

These are not all the possible symptoms of neuropathy. The symptoms of neuropathy can be different depending on the type of neuropathy and where the nerve damage occurs.^1,3

How is neuropathy diagnosed?

Doctors may use several lab tests and physical exams to diagnose neuropathy. Your doctor may check for signs of muscle weakness. They may also test whether your hands and feet can feel light touch and vibrations. Some other tests used to diagnose neuropathy are:^1,3

• Monofilament test – This test uses a thin, plastic wire to check whether you can feel things normally on the bottom of your feet. Your doctor may use this test to diagnose peripheral neuropathy.
• Electromyography – Your doctor may use this test to see how your muscles respond to electrical signals.
• Nerve conduction study – This test can help your doctor see how well your nerves are able to send electrical signals.
• Biopsy – This test involves taking a small sample from your skin or muscles to look at under a microscope.

Treatments for neuropathy

Treatment for neuropathy usually consists of managing the symptoms and reducing future nerve damage. Getting your blood sugar, blood pressure, and cholesterol to a healthy level will help lower the chances of further nerve damage. This can be done using prescription drugs. Certain changes in lifestyle, like eating a healthy diet and exercising, can also help achieve these goals.^1,6