Table of ContentsView AllTable of ContentsWhy It DevelopsWhat It’s LikeDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Why It Develops
What It’s Like
Diagnosis
Treatment
Neuropathy is nerve damage that causes tingling, numbness, pain, and other abnormal nerve sensations in the peripheral nerves (i.e., those of the arms and legs). It can occur for several reasons. Uremic neuropathy is a type that affects patients with advanced kidney disease or end-stage kidney disease patients who areon dialysis.
Unfortunately, neuropathy is very common in those with kidney disease. It may be related to nutrient imbalances, aspects of dialysis, or common overlapping conditions. The nerve damage may be permanent and get worse over time.
This article will look at possible reasons for neuropathy in kidney disease, what it’s like, and how it is diagnosed and treated.
BanksPhotos / Getty Images
Why Neuropathy Develops
People with advanced kidney disease or those on dialysis have a higher risk for uremic neuropathy.
The reason(s) for this are unclear, but it could be that:
With objective testing, more than half of dialysis patients could have signs of a nerve problem.Those who don’t get the minimum prescribed amount of dialysis have a higher risk of developing neuropathy.However, not everyone with neuropathy and kidney disease is on dialysis.
The high risk for neuropathy may also be associated with the underlying reason for developing nephropathy. Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD) requiring dialysis in the United States.Diabetes is associated with neuropathy.
What Neuropathy Is Like
Depending on the nerves affected, symptoms can vary.
People describe neuropathy as tingling, numbness, or pricking sensation in the hands or feet. Sometimes the pain is described as “burning” or “pins and needles.”
Causes of Hand and Foot Pain
Yourkidney specialist(nephrologist) may feel comfortable making a uremic neuropathy diagnosis based on symptoms alone.
However, if they’re not sure it’s neuropathy, they may send you to aneurologist. This type of doctor specializes in, among other things, the peripheral nerves—the 43 pairs of nerves throughout the body that communicate with the brain to make feeling and movement possible.
Additional tests may also be done depending on your specific symptoms.
A kidney transplant is the best treatment for uremic neuropathy.However, that’s really only a viable option if you’re already acandidate for a transplant. That leaves most people exploring other options.
As neuropathy can be a sign of inadequate dialysis, your kidney specialist will likely order blood tests to confirm you’re getting enough dialysis to remove the urea and other wastes from your system. If not, that will be adjusted.
Beyond that, treatments vary depending on what’s believed to be causing your neuropathy. Treating the underlying cause may relieve your symptoms.
For example, your doctor may look for vitamin and mineral deficiencies that could cause neuropathy. If any are found, you’ll likely be given supplements to increase levels. Nerve compression, such as carpal tunnel syndrome, may require physical therapy or surgery.
Medications
Topical relievers such as Zostrix (capsaicin) or Lidocaine patches also may be options.
If these measures fail, you may be prescribed a medication for neuropathy. Several classes of medication may be considered, including:
Opioids tend to be less effective than other drugs at treating neuropathic pain.
Other Treatments
Complementary treatments are sometimes used in neuropathy as well.
Summary
Kidney disease and dialysis can lead to neuropathy pain and muscle atrophy. The exact reasons for this are unknown but several possible causes exist. They include vitamin and mineral imbalances, added pressure from dialysis, and overlapping conditions.
Several tests can help your doctor diagnose neuropathy. Treatment may focus on the underlying cause (if it’s known) or on medications that manage your pain.
Prescription medications including antidepressants and anti-seizure drugs are common choices. Topical pain relievers and complementary treatments such as physical therapy and acupuncture may help as well.
Neuropathy Creams: Do They Work?
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Arnold R, Issar T, Krishnan AV, Pussell BA.Neurological complications in chronic kidney disease.JRSM Cardiovasc Dis. 2016;5:2048004016677687. doi:10.1177/2048004016677687Lin SY, Lin CL, Hsu WH, Lin CC, Lo SF, Kao CH.Risk of idiopathic peripheral neuropathy in end-stage renal disease: A population-based cohort study.Int J Clin Pract. 2021;75(1):e13641. doi:10.1111/ijcp.13641Hammond N, Wang Y, Dimachkie MM, Barohn RJ.Nutritional neuropathies.Neurologic Clinics. 2013;31(2):477-489. doi:10.1016/j.ncl.2013.02.002Diniz ET, Bandeira F, Lins OG, et al.Primary hyperparathyroidism is associated with subclinical peripheral neural alterations.Endocr Pract. 2013;19(2):219-225. doi:10.4158/EP12207.ORAwais M, Nicholas J, Al-saleh A, Dyer J.Ischaemic monomelic neuropathy (IMN) following vascular access surgery for haemodialysis: an under-recognized complication in non-diabetics.Clin Kidney J. 2012;5(2):140-142. doi:10.1093/ckj/sfs017Vahdatpour B, Maghroori R, Mortazavi M, Khosrawi S.Evaluation of ulnar neuropathy on hemodialysis patients.J Res Med Sci. 2012;17(10):905-910.Baumgaertel MW, Kraemer M, Berlit P.Neurologic complications of acute and chronic renal disease.Handb Clin Neurol. 2014;119:383-93. doi:10.1016/B978-0-7020-4086-3.00024-2Ghazan-Shahi S, Koh TJ, Chan CT.Impact of nocturnal hemodialysis on peripheral uremic neuropathy.BMC Nephrol. 2015;16:134. Published 2015 Aug 12. doi:10.1186/s12882-015-0133-2McGrath K, Edi R.Diabetic kidney disease: diagnosis, treatment, and prevention.afp. 2019;99(12):751-759.MedlinePlus.gov.Muscle atrophy.Cleveland Clinic.Neuropathy (peripheral neuropathy). Updated December 16, 2019.Ralph JW, Aminoff MJ.Chapter 59 - Neuromuscular complications of general medical disorders. In: Aminoff MJ, Josephson SA, ed.Aminoff’s neurology and general medicine, Fifth edition.Academic Press; 2014:1209-1242.University of Michigan Health, Michigan Medicine.Dialysis: Measuring how well it works. Updated December 17, 2020.NYU Langone Health.Medication for peripheral neuropathy.Raouf M, Bettinger J, Wegrzyn EW, Mathew RO, Fudin JJ.Pharmacotherapeutic management of neuropathic pain in end-stage renal disease.Kidney Dis (Basel). 2020;6(3):157-167. doi:10.1159/000504299Gu Y, Dennis SM.Are falls prevention programs effective at reducing the risk factors for falls in people with type-2 diabetes mellitus and peripheral neuropathy: A systematic review with narrative synthesis.J Diabetes Complications. 2017;31(2):504-516. doi:10.1016/j.jdiacomp.2016.10.004Thakral G, Kim PJ, LaFontaine J, Menzies R, Najafi B, Lavery LA.Electrical stimulation as an adjunctive treatment of painful and sensory diabetic neuropathy.J Diabetes Sci Technol. 2013;7(5):1202-1209. doi:10.1177/193229681300700510Dimitrova A.Introducing a standardized acupuncture protocol for peripheral neuropathy: A case series.Med Acupunct. 2017;29(6):352-365. doi:10.1089/acu.2017.1242Li K, Giustini D, Seely D.A systematic review of acupuncture for chemotherapy-induced peripheral neuropathy.Curr Oncol. 2019;26(2):e147-e154. doi:10.3747/co.26.4261
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Arnold R, Issar T, Krishnan AV, Pussell BA.Neurological complications in chronic kidney disease.JRSM Cardiovasc Dis. 2016;5:2048004016677687. doi:10.1177/2048004016677687Lin SY, Lin CL, Hsu WH, Lin CC, Lo SF, Kao CH.Risk of idiopathic peripheral neuropathy in end-stage renal disease: A population-based cohort study.Int J Clin Pract. 2021;75(1):e13641. doi:10.1111/ijcp.13641Hammond N, Wang Y, Dimachkie MM, Barohn RJ.Nutritional neuropathies.Neurologic Clinics. 2013;31(2):477-489. doi:10.1016/j.ncl.2013.02.002Diniz ET, Bandeira F, Lins OG, et al.Primary hyperparathyroidism is associated with subclinical peripheral neural alterations.Endocr Pract. 2013;19(2):219-225. doi:10.4158/EP12207.ORAwais M, Nicholas J, Al-saleh A, Dyer J.Ischaemic monomelic neuropathy (IMN) following vascular access surgery for haemodialysis: an under-recognized complication in non-diabetics.Clin Kidney J. 2012;5(2):140-142. doi:10.1093/ckj/sfs017Vahdatpour B, Maghroori R, Mortazavi M, Khosrawi S.Evaluation of ulnar neuropathy on hemodialysis patients.J Res Med Sci. 2012;17(10):905-910.Baumgaertel MW, Kraemer M, Berlit P.Neurologic complications of acute and chronic renal disease.Handb Clin Neurol. 2014;119:383-93. doi:10.1016/B978-0-7020-4086-3.00024-2Ghazan-Shahi S, Koh TJ, Chan CT.Impact of nocturnal hemodialysis on peripheral uremic neuropathy.BMC Nephrol. 2015;16:134. Published 2015 Aug 12. doi:10.1186/s12882-015-0133-2McGrath K, Edi R.Diabetic kidney disease: diagnosis, treatment, and prevention.afp. 2019;99(12):751-759.MedlinePlus.gov.Muscle atrophy.Cleveland Clinic.Neuropathy (peripheral neuropathy). Updated December 16, 2019.Ralph JW, Aminoff MJ.Chapter 59 - Neuromuscular complications of general medical disorders. In: Aminoff MJ, Josephson SA, ed.Aminoff’s neurology and general medicine, Fifth edition.Academic Press; 2014:1209-1242.University of Michigan Health, Michigan Medicine.Dialysis: Measuring how well it works. Updated December 17, 2020.NYU Langone Health.Medication for peripheral neuropathy.Raouf M, Bettinger J, Wegrzyn EW, Mathew RO, Fudin JJ.Pharmacotherapeutic management of neuropathic pain in end-stage renal disease.Kidney Dis (Basel). 2020;6(3):157-167. doi:10.1159/000504299Gu Y, Dennis SM.Are falls prevention programs effective at reducing the risk factors for falls in people with type-2 diabetes mellitus and peripheral neuropathy: A systematic review with narrative synthesis.J Diabetes Complications. 2017;31(2):504-516. doi:10.1016/j.jdiacomp.2016.10.004Thakral G, Kim PJ, LaFontaine J, Menzies R, Najafi B, Lavery LA.Electrical stimulation as an adjunctive treatment of painful and sensory diabetic neuropathy.J Diabetes Sci Technol. 2013;7(5):1202-1209. doi:10.1177/193229681300700510Dimitrova A.Introducing a standardized acupuncture protocol for peripheral neuropathy: A case series.Med Acupunct. 2017;29(6):352-365. doi:10.1089/acu.2017.1242Li K, Giustini D, Seely D.A systematic review of acupuncture for chemotherapy-induced peripheral neuropathy.Curr Oncol. 2019;26(2):e147-e154. doi:10.3747/co.26.4261
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Arnold R, Issar T, Krishnan AV, Pussell BA.Neurological complications in chronic kidney disease.JRSM Cardiovasc Dis. 2016;5:2048004016677687. doi:10.1177/2048004016677687Lin SY, Lin CL, Hsu WH, Lin CC, Lo SF, Kao CH.Risk of idiopathic peripheral neuropathy in end-stage renal disease: A population-based cohort study.Int J Clin Pract. 2021;75(1):e13641. doi:10.1111/ijcp.13641Hammond N, Wang Y, Dimachkie MM, Barohn RJ.Nutritional neuropathies.Neurologic Clinics. 2013;31(2):477-489. doi:10.1016/j.ncl.2013.02.002Diniz ET, Bandeira F, Lins OG, et al.Primary hyperparathyroidism is associated with subclinical peripheral neural alterations.Endocr Pract. 2013;19(2):219-225. doi:10.4158/EP12207.ORAwais M, Nicholas J, Al-saleh A, Dyer J.Ischaemic monomelic neuropathy (IMN) following vascular access surgery for haemodialysis: an under-recognized complication in non-diabetics.Clin Kidney J. 2012;5(2):140-142. doi:10.1093/ckj/sfs017Vahdatpour B, Maghroori R, Mortazavi M, Khosrawi S.Evaluation of ulnar neuropathy on hemodialysis patients.J Res Med Sci. 2012;17(10):905-910.Baumgaertel MW, Kraemer M, Berlit P.Neurologic complications of acute and chronic renal disease.Handb Clin Neurol. 2014;119:383-93. doi:10.1016/B978-0-7020-4086-3.00024-2Ghazan-Shahi S, Koh TJ, Chan CT.Impact of nocturnal hemodialysis on peripheral uremic neuropathy.BMC Nephrol. 2015;16:134. Published 2015 Aug 12. doi:10.1186/s12882-015-0133-2McGrath K, Edi R.Diabetic kidney disease: diagnosis, treatment, and prevention.afp. 2019;99(12):751-759.MedlinePlus.gov.Muscle atrophy.Cleveland Clinic.Neuropathy (peripheral neuropathy). Updated December 16, 2019.Ralph JW, Aminoff MJ.Chapter 59 - Neuromuscular complications of general medical disorders. In: Aminoff MJ, Josephson SA, ed.Aminoff’s neurology and general medicine, Fifth edition.Academic Press; 2014:1209-1242.University of Michigan Health, Michigan Medicine.Dialysis: Measuring how well it works. Updated December 17, 2020.NYU Langone Health.Medication for peripheral neuropathy.Raouf M, Bettinger J, Wegrzyn EW, Mathew RO, Fudin JJ.Pharmacotherapeutic management of neuropathic pain in end-stage renal disease.Kidney Dis (Basel). 2020;6(3):157-167. doi:10.1159/000504299Gu Y, Dennis SM.Are falls prevention programs effective at reducing the risk factors for falls in people with type-2 diabetes mellitus and peripheral neuropathy: A systematic review with narrative synthesis.J Diabetes Complications. 2017;31(2):504-516. doi:10.1016/j.jdiacomp.2016.10.004Thakral G, Kim PJ, LaFontaine J, Menzies R, Najafi B, Lavery LA.Electrical stimulation as an adjunctive treatment of painful and sensory diabetic neuropathy.J Diabetes Sci Technol. 2013;7(5):1202-1209. doi:10.1177/193229681300700510Dimitrova A.Introducing a standardized acupuncture protocol for peripheral neuropathy: A case series.Med Acupunct. 2017;29(6):352-365. doi:10.1089/acu.2017.1242Li K, Giustini D, Seely D.A systematic review of acupuncture for chemotherapy-induced peripheral neuropathy.Curr Oncol. 2019;26(2):e147-e154. doi:10.3747/co.26.4261
Arnold R, Issar T, Krishnan AV, Pussell BA.Neurological complications in chronic kidney disease.JRSM Cardiovasc Dis. 2016;5:2048004016677687. doi:10.1177/2048004016677687
Lin SY, Lin CL, Hsu WH, Lin CC, Lo SF, Kao CH.Risk of idiopathic peripheral neuropathy in end-stage renal disease: A population-based cohort study.Int J Clin Pract. 2021;75(1):e13641. doi:10.1111/ijcp.13641
Hammond N, Wang Y, Dimachkie MM, Barohn RJ.Nutritional neuropathies.Neurologic Clinics. 2013;31(2):477-489. doi:10.1016/j.ncl.2013.02.002
Diniz ET, Bandeira F, Lins OG, et al.Primary hyperparathyroidism is associated with subclinical peripheral neural alterations.Endocr Pract. 2013;19(2):219-225. doi:10.4158/EP12207.OR
Awais M, Nicholas J, Al-saleh A, Dyer J.Ischaemic monomelic neuropathy (IMN) following vascular access surgery for haemodialysis: an under-recognized complication in non-diabetics.Clin Kidney J. 2012;5(2):140-142. doi:10.1093/ckj/sfs017
Vahdatpour B, Maghroori R, Mortazavi M, Khosrawi S.Evaluation of ulnar neuropathy on hemodialysis patients.J Res Med Sci. 2012;17(10):905-910.
Baumgaertel MW, Kraemer M, Berlit P.Neurologic complications of acute and chronic renal disease.Handb Clin Neurol. 2014;119:383-93. doi:10.1016/B978-0-7020-4086-3.00024-2
Ghazan-Shahi S, Koh TJ, Chan CT.Impact of nocturnal hemodialysis on peripheral uremic neuropathy.BMC Nephrol. 2015;16:134. Published 2015 Aug 12. doi:10.1186/s12882-015-0133-2
McGrath K, Edi R.Diabetic kidney disease: diagnosis, treatment, and prevention.afp. 2019;99(12):751-759.
MedlinePlus.gov.Muscle atrophy.
Cleveland Clinic.Neuropathy (peripheral neuropathy). Updated December 16, 2019.
Ralph JW, Aminoff MJ.Chapter 59 - Neuromuscular complications of general medical disorders. In: Aminoff MJ, Josephson SA, ed.Aminoff’s neurology and general medicine, Fifth edition.Academic Press; 2014:1209-1242.
University of Michigan Health, Michigan Medicine.Dialysis: Measuring how well it works. Updated December 17, 2020.
NYU Langone Health.Medication for peripheral neuropathy.
Raouf M, Bettinger J, Wegrzyn EW, Mathew RO, Fudin JJ.Pharmacotherapeutic management of neuropathic pain in end-stage renal disease.Kidney Dis (Basel). 2020;6(3):157-167. doi:10.1159/000504299
Gu Y, Dennis SM.Are falls prevention programs effective at reducing the risk factors for falls in people with type-2 diabetes mellitus and peripheral neuropathy: A systematic review with narrative synthesis.J Diabetes Complications. 2017;31(2):504-516. doi:10.1016/j.jdiacomp.2016.10.004
Thakral G, Kim PJ, LaFontaine J, Menzies R, Najafi B, Lavery LA.Electrical stimulation as an adjunctive treatment of painful and sensory diabetic neuropathy.J Diabetes Sci Technol. 2013;7(5):1202-1209. doi:10.1177/193229681300700510
Dimitrova A.Introducing a standardized acupuncture protocol for peripheral neuropathy: A case series.Med Acupunct. 2017;29(6):352-365. doi:10.1089/acu.2017.1242
Li K, Giustini D, Seely D.A systematic review of acupuncture for chemotherapy-induced peripheral neuropathy.Curr Oncol. 2019;26(2):e147-e154. doi:10.3747/co.26.4261
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