Prevalence and predictors of sensory polyneuropathic signs and symptoms in kidney transplant recipients

S. Nolte, J.M.G. Hofman, A.W. Gomes Neto, B.T.A. de Greef, J.W.J. Elting, M.F. Eisenga, M. van Londen, S.J.L. Bakker, I.M. Nolte, C.G. Faber, J.S.F. Sanders, D.J. Touw, G.A.T. Lesman-Leegte, S. P. Berger, G. Drost

Thursday 5 march 2020

14:30 - 14:40h at Leo Franssen zaal

Parallel session: Parallel sessie XIV– Klinische abstracts

Background: Sensory polyneuropathy is a common finding in kidney transplant recipients (KTR). Patients with end stage renal disease are at a high risk to develop uremic or diabetic polyneuropathy. Kidney transplantation frequently fails to improve polyneuropathic signs and symptoms post-transplantation. So far, little is known about the exact prevalence of post-transplantation sensory polyneuropathy. Therefore, our aim is to determine prevalence and possible predictors of sensory polyneuropathy in KTR.

Methods: We included KTR and healthy subjects, examined prior to kidney donation. The primary outcome was the result of the adapted modified Toronto Clinical Neuropathy Score (amTCNS), a scoring tool designed to quantify neurological complaints and to rate symptoms of sensory polyneuropathy. Information on relevant clinical parameters i.e. age, height, weight, systolic blood pressure, diastolic blood pressure, hemoglobin levels, eGFR, levels of parathyroid hormone, potassium, folic acid, vitamin B-12, advanced glycation end product levels, HbA1c, use of calcineurin inhibitors, time since transplantation, and information on dialysis was collected from all subjects. A chi-square test was used to compare prevalence of sensory polyneuropathy between KTR and healthy subjects. Cumulative odds ordinal logistic regression analyses were performed to assess the relationship between explanatory variables and sensory polyneuropathy.

Results: A total of 209 KTR (65.1% males) with a mean age of 54.9±13.4 years, and 122 healthy subjects (46.7% males) with a mean age of 55.9±11.2 years were included. Signs and symptoms of sensory polyneuropathy were present in 48 (23.0%) KTR and in 6 (4.9%) healthy subjects (P<0.001). Age (OR=1.04, 95% CI=1.00-1.09, P=0.04), weight (OR=1.03, 95% CI=1.01-1.07, P=0.02), hemoglobin (OR=0.57, 95% CI=0.33-0.97, P=0.04), time since transplantation (OR=1.01, 95% CI=1.00-1.01, P=0.01), preemptive transplantation (OR=0.30, 95% CI=0.12-0.80, P=0.02) and advanced glycation end products score (OR=2.18, 95% CI=1.12-4.25, P=0.02) were associated with the odds of sensory polyneuropathy in KTR.

Conclusions: Polyneuropathic signs and symptoms were more than four times more frequent in KTR than in healthy subjects. Next to age, weight, hemoglobin, and time since transplantation, dialysis before transplantation was shown to be associated with the later presence of sensory polyneuropathy in KTR. Interestingly, advanced glycation end products were predictors of sensory polyneuropathy in KTR, even after correction for the presence of diabetes.