الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Background: End-stage renal disease (ESRD) is a major problem, hemodialysis (HD) is a form of renal replacement therapy (RRT). Dialysis-related amyloidosis (DRA) is one of the most dangerous consequences of HD. Patients with HD are more likely to carpal tunnel syndrome (CTS).
Aim of the study: This study was carried out to assess the prevalence of Carpal Tunnel Syndrome in hemodialysis patients using clinical criteria, musculoskeletal ultrasound and electrodiagnostic study.
Patients and methods: An observational cross-sectional study was conducted on seventy four non diabetic HD patients receiving hemodialysis on a regular basis for more than six months and their ages ranged from 27 to 70 years old, and a control group included 15 healthy volunteers for beta 2 microglobulin (B2M) comparison. The patients were asked about symptoms, examined for signs of CTS. Blood samples were collected for parathyroid hormone (PTH), calcium (Ca), phosphorus (Ph), B2M. Functional assessment of median nerve was done by nerve conduction study (NCS). Structural assessment was done using MSUS to measure Wrist forearm ratio (WFR).
Results: patients were classified according to NCS to four subgroups based on severity of CTS. There was a significant positive correlation between WFR with degree of CTS and PSL. There was also significant positive correlation between WFR and hemodialysis duration which played an important role in development of CTS among our patients. But there was significant negative correlation between hemodialysis duration with M amplitude. There was also significant positive correlation between Median nerve cross sectional area (MN-CSA) at wrist and level of Ca, level of Ph, PSL, Distal motor latency (DML) and M amp. The duration of dialysis is the predictor risk factor for CTS occurrence, but B2M did not play an important role in development of CTS among our patients as it had no significant correlation with WFR or NCS..
Conclusion: The prevalence of CTS in hemodialysis patients is 44.6% as proven by clinical assessment of patients and it was 70.3% in NCS and 50% in MSUS. Hypertension is most common cause of ESRD and hemodialysis after exclusion of DM. The duration of hemodialysis plays important role in development of CTS as it was the predictor risk factor for CTS among our patients. But level of B2M does not play the same role among our patients. MSUS is safe, effective, sensitive method for diagnosis of CTS in HD patients and its sensitivity is 71.2 % and specificity is100% as NCS was not accepted by all patients specially at side of AV shunt.