Nerve Dysfunction in Kidney Failure

Dr Matthew Kiernan, Prince of Wales Hospital Medical Research Institute

At the time of my application for funding to the Brain Foundation I had just returned to Sydney following a period of clinical training and post-doctoral research at both the National Hospital for Neurology and Neurosurgery and the Institute of Neurology, Queen Square, London UK. Since my return I have established research labs in the Department of Neurology, Prince of Wales Hospital and at the Prince of Wales Medical Research Institute. The award of the Brain Foundation Fellowship has enabled me to purchase the equipment items necessary to build a portable system of neurophysiological testing. This system allows patient testing to be undertaken in a dialysis unit, and can be moved from patient to patient during dialysis sessions.

Following the award by the Brain Foundation, a PhD student has started work in the department on the specific problem of nerve dysfunction in kidney failure. A preliminary study has been published in Brain, a highly ranked international neurology journal.

The leading causes of kidney failure in Australia are diabetes and high blood pressure. Other causes include infection, inflammation and drugs (especially analgesics). Over 6000 patients begin haemodialysis treatment in Australia every year and over 100,000 patients in the U.S. (ANZData 23rd Annual Report).

Renal failure results in neurological dysfunction due to uraemia, the accumulation of urea and other substances in the blood. This dysfunction may be manifest in the central, autonomic or peripheral nervous systems, with the incidence of peripheral neuropathy estimated to be 60-65% in patients beginning dialysis.

Kidney failure can occur at any age.

Studies are ongoing at Prince of Wales Hospital and are likely to impact on the future management of uraemic patients, both acutely and chronically. I am grateful for the support of the Brain Foundation in making these studies possible.

Kiernan MC, Walters RJL, Andersen KV, Taupe D, Murray NMF, Bostock H. (2002). Abnormal nerve excitability properties in patients with renal failure suggest membrane depolarization due to hyperkalemia. Brain 125:1366-1378.