Peritoneal Dialysis and Inflammatory Demyelinating Polyneuropathy: A Correlation or Co-Incidence?

Uremic neuropathy (UN) is a sensorimotor polyneuropathy typically affecting the lower extremities due to length-dependent demyelination and axonal degeneration. Hemodialysis (HD) and peritoneal dialysis (PD) are the two widely used modalities for treating end-stage renal disease (ESRD) patients. Today, with the understanding of solute and water kinetics, PD is considered equivalent to in-center HD. Chronic inflammatory demyelinating polyneuropathy (CIDP) manifests as symmetric, motor-predominant neuropathy that results in both proximal and distal muscle weakness. It is treatable with immune modulatory therapies. Here, we present a series of three patients who developed CIDP following the initiation of PD. Patient A: 39-year-old male with ESRD secondary to renal dysplasia presented with new onset neuropathy four months after starting PD. Patient B: 30-year-old male with ESRD secondary to IgA nephropathy presented with a history of numbness in his feet gradually progressing to his legs 12 months after initiating PD. Patient C: 56-year-old female with ESRD and uncontrolled diabetes mellitus presented with progressive muscle weakness four months after initiating PD. These three patients were all on continuous cycling PD. They were followed at three different dialysis units and were initiated on CCPD at different times. All of these patients were found to have CIDP on electromyography. Patients A and B were treated with IV immunoglobulin (IVIG) and improved, while patient C received plasmapheresis and improved. It has been recognized that PD solution is not physiological and may lead to activation of the host immune system triggering an autoimmune demyelinating process. Immunologic pathogenesis is not clearly understood. Macrophage activation and cytokines may play a role in the demyelination process. With the recent initiative to increase the use of PD, more studies are warranted to understand this uncommon complication.