Large and Small Fiber Neuropathy in Patients with Chronic Kidney Disease: A Case-Control Study from Iraq

Dheaaulden Abdulmunem, Safa; Bader Hamdan, Farqad; Sami Malik, Arif

doi:10.52573/ipmj.2025.163931

	Large and Small Fiber Neuropathy in Patients with Chronic Kidney Disease: A Case-Control Study from Iraq
Iraqi Postgraduate Medical Journal
Volume 25, Issue 2, April 2026, Pages 234-242 PDF (4.37 M)
Document Type: Research Paper
DOI: 10.52573/ipmj.2025.163931
Authors
Safa Dheaaulden Abdulmunem^* ¹; Farqad Bader Hamdan²; Arif Sami Malik³
¹Department of Neurophysiology, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq.
²Department of Medical Physiology, College of Medicine, Al-Nahrain University, Baghdad, Iraq.
³Professor of Internal Medicine, Consultant Nephrologist, Department of Medicine College of Medicine, Al-Nahrain University, Baghdad, Iraq.
Abstract
Background: Chronic kidney disease (CKD) is associated with neurological complications, including peripheral neuropathy. While large fiber neuropathy is commonly recognized in CKD, the involvement of small fibers and the influence of arteriovenous fistula (AVF) remain less well studied. This study aimed to investigate the presence of large and small fiber neuropathies in CKD patients and examine their correlation with demographic and clinical parameters. Methods: This case-control study included 40 participants: 20 CKD patients on maintenance hemodialysis and 20 age- and sex-matched healthy controls. All participants underwent neurophysiological assessments, including nerve conduction studies (NCS), sympathetic skin response (SSR), and cutaneous silent period (CSP) testing. Results: CKD patients exhibited prolonged sensory latencies (median nerve: 4.19 ± 0.49 ms vs. 3.30 ± 0.13 ms in controls; mean difference 0.89 ms, 95% CI 0.62–1.16, p < 0.001) and reduced SNAP amplitudes (22.03 ± 10.57 µV vs. 35.94 ± 9.05 µV; mean difference –13.91 µV, 95% CI –20.3 to –7.5, p = 0.001). SSR latency was prolonged and CSP latency and duration were significantly increased in the limb with AVF compared to controls and the contralateral limb. Conclusion: CKD patients on dialysis exhibit both large and small fiber neuropathy. Electrophysiological changes are more pronounced in limbs with AVF. Regular neurophysiological monitoring can aid in the early detection and management of conditions.
Keywords
Chronic kidney disease; peripheral neuropathy; hemodialysis; nerve conduction studies; arteriovenous fistula

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