Pain in the feet

Ask Our Experts Dr. John Agar, Nephrologist
1

Hello Dr. Agar,

About 5 yeas back, I was diagnosed with peripheral neuropathy after I complained to my nephrologist of numbness in my feet. Nerve conduction studies were performed and this diagnosed was arrived at. The neurologist put me on some medication but it did not help at all and he then asked me to discontinue it.

From the last month or so, the numbness has degenerated into pain. The pain is markedly increased when I am walking or climbing down a flight of stairs.

I went back to my nephrologist who wanted to rule out schema and vascular calcification. The X Rays and arterial doppler have since ruled them out. It does look like the neuropathy is getting worse and is now paining. My neph has started me on gabapentin which I haven’t had much success with earlier.

I wanted to check with you if neuropathy is common even in daily nocturnal patients - I get six nights of 7 to 7.5 hours dialysis. Could it be that /i use high flux dialyzers only alternate nights with a low flux dialyzer on other nights? I also reuse the dialyzers six times. Given that on nocturnal I am supposed to be getting much better dialysis, shouldn’t the neuropathy not get worse?

Thanks
Kamal

2

Dear Kamal

Unfortunately, CKD and dialysis-related neuropathy has a horrid tendency to be progressive and, while there is some data out there that suggests that some patients experience at least a partial remission of their pre-existing neuropathy with higher frequency, more intensive dialysis regimens, this is not by any means the case with all. While we have not had patients develop a new neuropathy whilst on intensive dialysis, once present, it may not then always improve or regress.

3

Thanks Dr. Agar!

Are there any drugs that help symptomatically at least?

4

To be honest, I would likely go for gabapentin too