Endocrine Abstracts

Background and aim: We carried out a prospective 1-year study to examine the association of sudomotor dysfunction with mortality in patients with chronic kidney disease.

Materials and methods: 97 patients from dialysis unit (28 with diabetic nephropathy (DN); 37 with nephroangiosclerosis, (NA), 18 with glomerulonephritis (GN), 14 with other conditions (O)); 32 with type 2 DM and creatinine clearance (CrCl) 30–50 ml/min; and 24 transplanted patients with CrCl>30 ml/min (of these eight had DM). Neuropathy was documented using the Neuropathy Disability Score (NDS) and the Neuropad® test. Peripheral vascular disease (PAD) was diagnosed by CW Doppler. Investigations were performed twice: 1 and 2 years ago.

Results: Among DM patients, 13 exhibited diabetic foot pathology, one patient with critical ischaemia in the NA group and 1 in the GN group. 14 patients on haemodialysis had died: 9 in the NA group (mean age 66.8±11 years), four among DM (mean age 59±11.9 years), and 1 in the O group (73 years). In univariate analysis, diabetic foot was related to dialysis treatment (OR: 1.18, 95% CI: 1.09–1.29, P=0.02)), PAD (OR: 0.55, 95% CI: 0.47–0.64, P=0.01)), VPT (OR: 12.6, 95% CI: 2.7–58.1, P<0.001)), sensory loss (OR: 548, 95% CI: 52.9–56.82, P<0.001)). Death was related to age (OR: 1.06, 95% CI: 1–1.11, P=0.02)), dialysis treatment (OR: 1.17, 95% CI: 1.08–1.27, P=0.003)), VPT (OR: 3.1, 95% CI: 0.99–9.8, P=0.04)), loss of ankle reflexes (OR: 1.7, 95% CI: 1.1–2.8, P=0.007)), and abnormal Neuropad response (OR: 1.1, 95% CI: 1.03–1.19, P=0.004)). In multivariate analysis, only abnormal Neuropad test remained significant (P<0.05; 26.4±8.2 min in patients who had died and 17.8±9.8 in alive; P=0.002).

Conclusions: Sudomotor dysfunction is associated with increased mortality in patients with chronic kidney disease, with or without DM. Neuropad^® test should be added as a sceening tool for diabetic foot syndroma. Both methods would be prognostic not only for the fate of leg but also fate of the patient.