Facial nerve injury in dialysed patients with end stage renal failure

• Published in: Neurophysiologie clinique Vol. 48; no. 3; p. 135
• Main Authors: Kharrat, Ferdaous, Hdiji, Olfa, Sakka, Salma, Farhat, Nouha, Kacem, Hanen Haj, Damak, Mariem, Mhiri, Chokri
• Format: Journal Article
• Language: English
• Published: Paris Elsevier Masson SAS 01-06-2018; Elsevier Science Ltd
• Subjects: Anuria; Bells palsy; Body mass; Dialysis; Facial nerve; Hemodialysis; Kidney cancer; Kidneys; Peripheral neuropathy; Peritoneal dialysis; Peritoneum; Renal failure; Risk factors; Facial nerve; Dialysis; Renal failure
• ISSN: 0987-7053; 1769-7131
• DOI: 10.1016/j.neucli.2018.05.020

End stage renal failure (ESRF) is a major health problem. Patients ongoing dialysis are prone to have damages in the peripheral nerve system. Our aim is to identify facial nerve injury among these patients.
In our study we included all the patients diagnosed with ESRF undergoing hemodialysis (HD) or peritoneal dialysis (PD) in Dialysis Unit of Hedi Chaker Hospital who were referred to our neurophysiology unit for electrodiagnosis of neuro-uremic complications over a period of 12 months.
Sixty-five patients were enrolled of which 45 were under hemodialysis and 20 under peritoneal dialysis. We identified facial nerve injury in 8 patients (12.3%), 6 and 2 patients under HD and PD respectively. The mean age was 57.4±16.3 years old. Male to female ratio was 1. On examination, all the patients were asymptomatic. Facial neuropathy was predominantly bilateral, in its axonal type, found in 7 cases respectively. Facial nerve injury was associated with carpal tunel syndrome in 2 cases and polyneurpathy in all patients. Facial neuropathy was significantly correlated with older age, increased body mass idex, anuria and the duration of dialysis. The biological investigation showed high kaliemia and β2-microglobulinemia.
Cranial nerve injury in end stage renal failure patients is well recognized particularly cochleovestibular nerve. Facial neuropathy is reported as well but in less proportions. It is frequently asymptomatic. In the literature, the incrimination of the dialysis type in the occurrence of facial neuropathy is not established. Risk factors for this neuropathy are not specific, but are those of the uremic neuropathy, in general. Patients with end stage renal failure under dialysis are at risk of having uremic neuropathy, of which facial nerve injury is a particular form. As it is frequently asymptomatic, it should be systematically detected on electroneuro myographic study.