H-L Lin1, H-C Lin, Y-H Chen. 1. Department of Neurology, General Cathay Hospital, Sijhih Branch, Taipei, Taiwan.
Abstract
AIMS: Movement disorders are one of the central nervous system complications in uremic patients. Asterixis, multifocal myoclonus, and restless leg syndrome are well-documented in this category. Acute parkinsonism, however, is only reported in rare series with a small number of cases. In this study, we investigated the risk for parkinsonism during a 3-year follow-up period after a diagnosis of uremia. METHODS: The Longitudinal Health Insurance Database in Taiwan was utilised. We identified a total of 2862 patients who had visited ambulatory care centers with a diagnosis of chronic renal failure between 1999 and 2001 as the study cohort. We further randomly selected 14,310 enrollees matched with the study cohort in terms of gender, age, and year of their index visit for comparison. Each patient was individually tracked for 3 years to identify the occurrence of parkinsonism. Stratified Cox proportional hazard regressions (stratified by age and gender) were performed for analyses. RESULTS: We found the annual incidence rates of parkinsonism to be 1.2% and 0.6% in the uremic and non-uremic groups, respectively. Furthermore, uremic patients were more vulnerable to developing parkinsonism with a 1.81-fold higher risk [95%CI = (1.21-2.71)] than the non-uremic group after adjusting for diabetes mellitus, which did not augment the risk. CONCLUSIONS: The importance of raising awareness regarding the early symptoms of parkinsonism among patients with uremia is tied to its early identification, with timely aggressive dialysis being able to apply to slow the progression of the disease and its symptoms. Further study is warranted to elucidate the pathophysiology of uremic parkinsonism.
AIMS: Movement disorders are one of the central nervous system complications in uremicpatients. Asterixis, multifocal myoclonus, and restless leg syndrome are well-documented in this category. Acute parkinsonism, however, is only reported in rare series with a small number of cases. In this study, we investigated the risk for parkinsonism during a 3-year follow-up period after a diagnosis of uremia. METHODS: The Longitudinal Health Insurance Database in Taiwan was utilised. We identified a total of 2862 patients who had visited ambulatory care centers with a diagnosis of chronic renal failure between 1999 and 2001 as the study cohort. We further randomly selected 14,310 enrollees matched with the study cohort in terms of gender, age, and year of their index visit for comparison. Each patient was individually tracked for 3 years to identify the occurrence of parkinsonism. Stratified Cox proportional hazard regressions (stratified by age and gender) were performed for analyses. RESULTS: We found the annual incidence rates of parkinsonism to be 1.2% and 0.6% in the uremic and non-uremic groups, respectively. Furthermore, uremicpatients were more vulnerable to developing parkinsonism with a 1.81-fold higher risk [95%CI = (1.21-2.71)] than the non-uremic group after adjusting for diabetes mellitus, which did not augment the risk. CONCLUSIONS: The importance of raising awareness regarding the early symptoms of parkinsonism among patients with uremia is tied to its early identification, with timely aggressive dialysis being able to apply to slow the progression of the disease and its symptoms. Further study is warranted to elucidate the pathophysiology of uremic parkinsonism.
Authors: Sophie Liabeuf; Marion Pepin; Casper F M Franssen; Davide Viggiano; Sol Carriazo; Ron T Gansevoort; Loreto Gesualdo; Gaye Hafez; Jolanta Malyszko; Christopher Mayer; Dorothea Nitsch; Alberto Ortiz; Vesna Pešić; Andrzej Wiecek; Ziad A Massy Journal: Nephrol Dial Transplant Date: 2021-12-28 Impact factor: 5.992