Background: While the reported prevalence of neuropathy is high in adults with Chronic Kidney Disease (CKD), there are limited studies in children. This cross sectional study was planned to estimate the burden of neuropathy in children with CKD and to determine the possible risk factors.

Methods: During May 2012 to December 2012, normally nourished children, aged 3-18 years, with CKD stage IV and V of non-diabetic etiology underwent detailed history and neurological examination. Motor nerve conduction, sensory nerve conduction, estimation of minimum F wave latencies and F estimate calculation were performed. Blood samples were analyzed for biochemical parameters like urea, creatinine, uric acid, potassium, calcium, phosphate, alkaline phosphatase, ferritin, albumin and triglycerides; trace elements like zinc, copper and selenium and vitamins including retinol, tocopherol, vitamin C, vitamin B₁₂ and folic acid.

Results: Of 50 enrolled children, the prevalence of electrophysiologically defined peripheral neuropathy was 52% (95% CI-37.65, 66.34).  Majority (80.8%) had axonal and only 11.5% had demyelinating neuropathy. Isolated motor neuropathy was present in 92.3% and sensorimotor neuropathy in 7.6%. Posterior tibial and common peroneal nerves were predominantly involved. Absent F wave response was observed in 16%, mostly involving the common peroneal nerves.

Conclusion: Over half of the children with CKD stage IV and V had electrophysiological evidence of peripheral neuropathy. Less than 25% had any motor/sensory symptoms or signs. Risk factors for CKD related neuropathy were older age, children on dialysis, low copper, high ferritin and low albumin.