Factors Affecting Carpal Tunnel Syndrome in End Stage Renal Disease with Maintenance Hemodialysis: A Systematic Review

  • Dary Gunawan Faculty of Medicine, Udayana University, Bali, Indonesia
  • Theodore Dharma Tedjamartono Faculty of Medicine, Udayana University, PB Sudirmanno. 6A, Denpasar Barat, Bali, Indonesia


Introduction: The number of patients with End Stage Renal Disease (ESRD) is increasing every year, as well as those who have to undergo hemodialysis. Most hemodialysis must be undertaken in a long time. Long term hemodialysis is known to be associated with the incidence of Carpal Tunnel Syndrome (CTS).

Method: This study aimed to systematically review factors contributing in the mentioned problem. Literature research was done using three search engines, consist of Google Scholar, Pubmed and ProQuest. Journals used are limited to the last 5 years or those deemed to be relevant. The studies obtained were further read and and appraised critically.

Result and Discussion: From a total of 423 journals, 4 articles were selected based on inclusion and exclusion criteria. The prevalence of CTS was found to be higher in ESRD patients undergoing maintenance hemodialysis (MHD). Age, Gender, MHD Duration, β2-Microglobulin are factors that have long been known to play a role. Several other factors such as serum prealbumin, serum albumin, Blood Lead Levels, hepatitis infection, wrist injury, predialytic urea serum and BMI have been implicated in the incidence of CTS in ESRD patients undergoing MHD in some literatures.

Conclusion: The factors mentioned earlier were found to have different roles and it is interesting for further reviewed. However, unfortunately there is still very little research that discuss these matters and more research needs to be done related to the factors above.

Keywords: Chronic kidney disease, hemodialysis, carpal tunnel syndrome, dialysis related amyloidosis


Download data is not yet available.


1. Manktelow RT, Binhammer P, Tomat LR, Bril V, Szalai JP. Carpal Tunnel Syndrome: Cross-Sectional and Outcome Study in Ontario Workers. J Hand Surg Am. 2004;29(2):307–17.
2. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a. 2002;7.
3. Middleton SD, Anakwe RE. Carpal tunnel syndrome. BMJ. 2014;349(November):1–7.
4. Report S. Incidence of common compressive neuropathies in primary care. 2006;263–5.
5. Cardiol JAC. Ess s ore. 2011;171(10):2010–1.
6. Ranstam J, Rose I. Prevalence of Carpal Tunnel Syndrome. 2015;
7. Tsai Matched ANP, Study C. Incidence and Risk of Carpal Tunnel Syndrome in End-Stage Renal Disease Patients on Dialysis. 2020;84(January):100–6.
8. Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal Tunnel Syndrome : A Review of the Recent Literature. 2012;69–76.
9. Frcp C, Cestero RVM, Baum J. Tunnel Syndrome in Patients Undergoing Maintenance Hemodialysis Methemoglobinemia Resulting Absorption of Nitrates. 2015;1–2.
10. Himmelfarb J, Stenvinkel P, Ikizler TA, Hakim RM. Perspectives in renal medicine: The elephant in uremia: Oxidant stress as a unifying concept of cardiovascular disease in uremia. Kidney Int. 2002;62(5):1524–38.
11. Kocyigit I, Unal A, Guney A, Mavili E, Deniz K, Kocyigit M, et al. Carpal tunnel release surgery and venous hypertension in early hemodialysis patients without amyloid deposits. Sci World J. 2013;2013.
12. Leon C, Asif A. Arteriovenous Access and Hand Pain : The Distal. 2007;175–83.
13. Schiffl H. Impact of advanced dialysis technology on the prevalence of dialysis-related amyloidosis in long-term maintenance dialysis patients. Hemodial Int. 2014;18(1):136–41.
14. Matsuo K, Ikizler TA, Hoover RL, Nakamoto M, Yasunaga C, Pupim LB, et al. Transforming growth factor-β is involved in the pathogenesis of dialysis-related amyloidosis. Kidney Int. 2000;57(2):697–708.
15. Kang HJ, Koh IH. Does Carpal Tunnel Release Provide Long-Term Relief in Patients with Hemodialysis-Associated Carpal Tunnel Syndrome ? 2012;2561–5.
16. Tsai CH, Hsu HH, Chen SH, Chien L, Lin JAJ, Chang CJ, et al. Incidence and Risk of Carpal Tunnel Syndrome in End-Stage Renal Disease Patients on Dialysis: A Nationwide Population-Based Matched Cohort Study. Ann Plast Surg. 2020;84(1S Suppl 1):S100–6.
17. Rjpm S, Bmj U, Lm B, Hcw V. Surgical treatment options for carpal tunnel syndrome (Review). 2007;
18. Turner A, Kimble F, Gulyás K, Ball J. Can the outcome of open carpal tunnel release be predicted?: A review of the literature. ANZ J Surg. 2010;80(1–2):50–4.
19. Hoshino J, Kawada M, Imafuku A, Mise K. A clinical staging score to measure the severity of dialysis-related amyloidosis. Clin Exp Nephrol. 2016;1–3.
20. Title T. Systematic review.
21. Kuharić M, Zibar L. Screening for Carpal Tunnel Syndrome in Patients on Chronic Hemodialysis. Acta Med Acad. 2019;48(2):167–76.
22. Fischer J, Thompson NW, Harrison JWK. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. Class Pap Orthop. 2014;75(11):349–51.
23. Dung NH, Loc ND, Quyen DBQ, Tuan NM, Tuan PNH, Quyet D, et al. Association between low serum prealbumin levels and carpal tunnel syndrome in maintenance hemodialysis patients. Ren Fail [Internet]. 2020;42(1):944–9. Available from: https://doi.org/10.1080/0886022X.2020.1811118
24. Huang WH, Hu CC, Yen TH, Hsu CW, Weng CH. Blood lead level: an overlooked risk of carpal tunnel syndrome in hemodialysis patients. Ren Fail [Internet]. 2019;41(1):786–93. Available from: https://doi.org/10.1080/0886022X.2019.1657894
25. Nishi S, Hoshino J, Yamamoto S, Goto S, Fujii H, Ubara Y, et al. Multicentre cross-sectional study for bone-articular lesions associated with dialysis related amyloidosis in Japan. Nephrology. 2018;23(7):640–5.
26. Keith MW, Masear V, Chung K, Maupin K, Andary M, Amadio PC, et al. Diagnosis of carpal tunnel syndrome. J Am Acad Orthop Surg. 2009;17(6):389–96.
27. Kopeć J, Ga̧dek A, Drozdz M, Miśkowiec K, Dutka J, Sydor A, et al. Carpal tunnel syndrome in hemodialysis patients as a dialysis-related amyloidosis manifestation - incidence, risk factors and results of surgical treatment. Med Sci Monit. 2011;17(9):505–9.
28. Stage E, Disease R, Networks E, England N, Networks E, England N. Incidence, prevalence, patient characteristics, & treatment modalities. Am J Kidney Dis. 2014;63(1 SUPPL.):1–31.
29. Mitake T, Iwatsuki K, Hirata H. Differences in characteristics of carpal tunnel syndrome between male and female patients. J Orthop Sci [Internet]. 2020;25(5):843–6. Available from: https://doi.org/10.1016/j.jos.2019.10.017
30. Huang WH, Hsu CW, Weng CH, Yen TH, Lin JH, Lee M. Association of a high normalized protein catabolic rate and low serum albumin level with carpal tunnel syndrome in hemodialysis patients. Med (United States). 2016;95(26):1–8.
31. Gejyo F, Amano I, Ando T, Ishida M, Obayashi S, Ogawa H, et al. Survey of the Effects of a Column for Adsorption of β2-Microglobulin in Patients With Dialysis-Related Amyloidosis in Japan. Ther Apher Dial. 2013;17(1):40–7.
32. Yamamoto Y, Hirawa N, Yamaguchi S, Ogawa N, Takeda H, Shibuya K, et al. Long-Term Efficacy and Safety of the Small-Sized β2-Microglobulin Adsorption Column for Dialysis-Related Amyloidosis. Ther Apher Dial. 2011;15(5):466–74.
33. Porter MY, Routledge KE, Radford SE, Hewitt EW. Characterization of the response of primary cells relevant to dialysis-related amyloidosis to β 2-microglobulin monomer and fibrils. PLoS One. 2011;6(11).
34. Chertow GM, Ackert K, Lew NL, Lazarus JM, Lowrie EG. Prealbumin is as important as albumin in the nutritional assessment of hemodialysis patients. Kidney Int. 2000;58(6):2512–7.
35. Lukowsky LR, Kheifets L, Arah OA, Nissenson AR, Kalantar-Zadeh K. Nutritional predictors of early mortality in incident hemodialysis patients. Int Urol Nephrol. 2014;46(1):129–40.
36. Cheng YJ, Liu MY. Modulation of tumor necrosis factor-α and oxidative stress through protein kinase C and P42/44 mitogen-activated protein kinase in lead increases lipopolysaccharide-induced liver damage in rats. Shock. 2005;24(2):188–93.
37. Jomova K, Valko M. Advances in metal-induced oxidative stress and human disease. Toxicology [Internet]. 2011;283(2–3):65–87. Accessed: January 9th-2021, Available from: http://dx.doi.org/10.1016/j.tox.2011.03.001
142 Views | 97 Downloads
How to Cite
Gunawan, D., and Theodore Dharma Tedjamartono. “Factors Affecting Carpal Tunnel Syndrome in End Stage Renal Disease With Maintenance Hemodialysis: A Systematic Review”. World Journal of Current Medical and Pharmaceutical Research, Feb. 2021, pp. 05-12, doi:10.37022/wjcmpr.vi.164.
Review Articles