Shear Wave Elastography in the Diagnosis of Peripheral Neuropathy in Patients With Chronic Kidney Disease Stage 5

Objective: To observe the feasibility of shear wave elastography (SWE) in the diagnosis of peripheral neuropathy in patients undergoing hemodialysis [chronic kidney disease stage 5 dialysis (CKD5D)].

Methods: Forty patients with CKD5D were divided into a uremic peripheral neuropathy (UPN) group (n = 25) and a non-UPN group (n = 15) according to the results of a neuro-electrophysiological examination. Sixteen healthy control subjects were also enrolled in this study. Two-dimensional ultrasound examination was conducted, and SWE was then performed to measure Young's modulus of the tibial nerve. The left and right diameters (D1), anterior and posterior diameters (D2), perimeter (C), cross-sectional area (CSA), and Young's modulus (E) were measured three times at the same non-entrapment site. The average values were recorded and calculated. The following evaluation indices were also analyzed: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC).

Results: D1, D2, C, and CSA were not significantly different among the three groups (P > 0.05). However, the difference in the E value among the three groups was statistically significant (P < 0.05). The AUC was 0.889 based on the E value. Using a tibial nerve E value of 48.35 kPa as the cutoff value, the sensitivity, specificity, PPV, and NPV were 86.0%, 84.0%, 81.1%, and 88.1%, respectively.

Conclusions: SWE is useful for the diagnosis of peripheral neuropathy in patients with CKD5D. Young's modulus of 48.35 kPa for the tibial nerve is the optimal cutoff value and has the best diagnostic efficiency for peripheral neuropathy in CKD5D patients.