Ischaemia induces paradoxical changes in axonal excitability in end-stage kidney disease

Brain : a Journal of Neurology
Arun V KrishnanMatthew C Kiernan

Abstract

Peripheral neuropathy is present in 65% of patients with end-stage kidney disease (ESKD). No cause is yet established: nerve excitability studies have shown that axons are chronically depolarized, primarily owing to hyperkalaemia, but in vitro studies have suggested a role for axonal Na+/K+ pump dysfunction. To investigate Na+/K+ pump activity in vivo, lower limb ischaemia was induced in five ESKD patients and six healthy controls by a sphygmomanometer cuff, inflated to 200 mm Hg and maintained for 13 min. The peroneal nerve was stimulated at the fibular neck and excitability parameters were recorded from tibialis anterior (TA) and extensor digitorum brevis (EDB) before, during and after the ischaemic period. Baseline excitability studies in ESKD patients demonstrated reductions in threshold electrotonus and superexcitability and increased refractoriness, consistent with membrane depolarization. During ischaemia, threshold increased in ESKD patients [by +23.6 +/- 5.0% (TA); +32.1 +/- 7.3% (EDB)] in contrast to the persistent threshold reduction observed in normal controls [-2.4 +/- 5.2% (TA); -13.0 +/- 8.2% (EDB); P < 0.01]. These changes were accompanied by increased refractoriness and reduced superexcitability in both ESKD an...Continue Reading

Citations

Sep 3, 2009·Nature Reviews. Neurology·Arun V Krishnan, Matthew C Kiernan
Apr 24, 2009·Seminars in Dialysis·Arun V KrishnanMatthew C Kiernan
Oct 10, 2014·Continuum : Lifelong Learning in Neurology·Nathan P Staff, Anthony J Windebank
Feb 26, 2010·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·Arun V Krishnan
Aug 25, 2009·Progress in Neurobiology·Arun V KrishnanMatthew C Kiernan
Nov 28, 2008·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·Robert A BolandMatthew C Kiernan
Jun 24, 2008·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·S E HanMatthew C Kiernan
Jan 1, 2010·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Rodica Pop-BusuiEva L Feldman
Dec 30, 2006·Muscle & Nerve·Arun V Krishnan, Matthew C Kiernan
Dec 12, 2012·Muscle & Nerve·Arun V KrishnanMatthew C Kiernan
May 21, 2013·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·Ria ArnoldArun V Krishnan
May 31, 2017·Muscle & Nerve·Adeniyi A BorireArun V Krishnan
Mar 19, 2008·Journal of the Peripheral Nervous System : JPNS·Arun V KrishnanMatthew C Kiernan
Sep 20, 2018·Internal Medicine Journal·Ria ArnoldArun V Krishnan
Sep 1, 2019·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·Matthew C KiernanDavid Burke

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