Stage-Specific Electroneuromyographic Patterns and Laboratory Markers of Uremic Neuropathy Severity

Objective. To characterize electroneuromyographic (ENMG) abnormalities and evaluate laboratory markers associated with peripheral neuropathy severity across chronic kidney disease (CKD) stages. Material and methods. This cross-sectional observational study included 65 patients with CKD (stage I, n=9; stage II, n=14; stage III, n=8; stage IV, n=8; stage V, n=26) and a healthy control group for electrophysiological comparison. Peripheral neuropathy was classified into stages 0–3 using an adapted Dyck staging approach. Bilateral motor nerve conduction studies assessed nerve conduction velocity (NCV) and compound muscle action potential (M-response) amplitude in the median, ulnar, tibial, and peroneal nerves. Receiver operating characteristic (ROC) analysis evaluated creatinine, urea, potassium, erythrocyte sedimentation rate (ESR), ferritin, and parathyroid hormone (PTH). Results. Among 65 patients, 24.6% had no neuropathy, 36.9% had subclinical neuropathy, 33.8% had symptomatic neuropathy, and 4.6% had disabling neuropathy. Axonal and mixed patterns predominated. Patients receiving hemodialysis had lower NCV and M-response amplitudes in all examined nerves (all p<0.001). Potassium showed the strongest discrimination for symptomatic neuropathy (cut-off 5.08 mmol/L; sensitivity 95.0%; specificity 78.3%; AUC 0.868), whereas PTH showed high discrimination for subclinical neuropathy (cut-off 146.05 pg/mL; sensitivity 88.9%; specificity 86.5%; AUC 0.898). Conclusion. ENMG abnormalities increased with neuropathy severity. Serum potassium and PTH were associated with clinically relevant neuropathy stages and may be useful candidate markers; however, the proposed cut-offs require prospective external validation.

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