SUDOSCAN has proved its effectiveness in the field of Nephrology
Peripheral autonomic neuropathy is the result of damage to the peripheral nerves, or small fiber neuropathy due to myelinated nerves (Type Aδ), as well as non-myelinated nerves (non-myelinated Group C fibers). In peripheral neuropathy, the small somatic and autonomic fibers can be affected. These small fibers control temperature perception, pain perception and autonomic functioning, such as the cardiac, pulmonary and enteric system. [1].
Peripheral neuropathy can be a complication of several illnesses, including diabetes, neurological or metabolic problems and infections.
Diabetic neuropathy can manifest in people who are in the early stages of diabetes. Sudoscan enables early testing for microvascular symptoms, helping doctors to provide better care to their patients and prevent serious complications.
Sudoscan can also help to evaluate patients in the advanced stages of the disease, who are at risk from developing severe complications associated with their illness (such as intradialytic hypotension or cardiac autonomic neuropathy).
1 – SUDOSCAN detects those at high risk of diabetic nephropathy [2]
Background : The study evaluates the effectiveness of Sudoscan (®) to detect diabetic kidney disease (DKD) in Chinese patients with Type 2 Diabetes. Considering the link between dysglycemia, vasculopathy and neuropathy, an early identification of DKD is crucial.
Methodology: The Sudoscan measurement is taken from 50 patients with Type 2 diabetes not exhibiting DKD and 50 Type 2 diabetic patients with DKD. A statistical analysis was taken to establish a correlation between the Sudoscan measurement and the indicators of renal function to determine its sensitivity and specificity in detecting DKD.
Results: The Sudoscan measurements were closely related to the indicators of renal function and albuminuria. A Sudoscan measurement lower than 55 showed a high rate of sensitivity (94%) and a specificity of 78% for detection of DKD. Furthermore, after an adjustment for other risk factors, Sudoscan was able to independently associate it with DKD. The patients with a low Sudoscan measurement without DKD had a longer period of illness and were more susceptible to complications associated with diabetes.
2 – SUDOSCAN can be used to evaluate the risk of intradialytic hypotension (IDH) on patients undergoing hemodialysis (HD) [3]
Background: intradialytic hypotension (IDH) is frequently seen in patients undergoing hemodialysis (HD) and is linked to several risk factors, including cardiac and autonomic nervous system anomalies. The study evaluates the clinical benefits of Sudoscan® in predicting IDH by quantifying dysautonomia.
Methodology : A prospective monocentric study was conducted on adults undergoing HD. The dysautonomia was evaluated by electrochemical conductivity of the skin (ESC) through the hands and feet with the Sudoscan® before the dialysis session. The principal criteria was the incidence of IDH throughout the course of the study.
Results: In the 176 patients, a significant proportion presented a high ESC pathology in the hands and feet. IDH occurred in 46 patients. An ESC pathology present pre-dialysis in the hands is associated with an increased risk of IDH. The cumulative risk of IDH was significantly higher in patients presenting an ESC pathology in the feet or hands.
3 – Association of electrochemical skin conductance measured
by Sudoscan and cardiovascular results in patients undergoing hemodialysis [4]
Context: Cardiac autonomic neuropathy (CAN) is a frequent complication of patients with terminal renal failure and a risk factor for sudden death. Principally caused by diabetic mellitus, it is also associated with obesity, cardiovascular illnesses and uremia. CAN manifests through a lowering of the heart rate variability (HRV) and, at advanced stages, through symptoms such as orthostatic hypotension and silent myocardial ischemia. The tests to evaluate CAN are time-consuming and impractical for routine clinical use.
Methodology: This study evaluated the Sudoscan, a non-invasive device measuring the electrochemical skin conductance (ESC) to predict major adverse cardiovascular events (MACE) in 176 hemodialysis (HD) patients in 24 months. The patients were followed for the first signs of MACE (AVC, myocardial infarction) or death.
Results: In the 24 months of the study, 41 patients had their first MACE event and 37 had died. The patients with MACE were older, more frequently diabetic and had a higher level of atrial fibrillation. The average ESC of the feet before dialysis was significantly lower in patients with MACE (47 mS) as opposed to patients without MACE (57 mS). An ESC pathology in the feet was associated with an increased risk of death (HR = 3.74) and of MACE (HR = 2.88). However, no association was observed in the ESC of the hands.
SUDOSCAN Benefits
Fast
No patient preparation
Results in 3 minutes
Easy-to-read critical data points to help physicians reach a diagnosis
Secure
Non-invasive
No fasting
Easy to operate
CE and FDA approvals
Accurate
Reproducible quantitative results
Independent from environmental conditions
Backed by evidence-based research
150 peer-reviewed journals publications
References
[1] Levine TD. Small Fiber Neuropathy : Classification des maladies au-delà de la douleur et de la brûlure. J Cent Nerv Syst Dis.2018;10:1179573518771703. Publié 2018 Apr 18.[2] Kharoubi M, Roche F, Bézard M, Hupin D, Silva S, Oghina S, Chalard C, Zaroui A, Galat A, Guendouz S, Canoui-Poitrine F, Hittinger L, Teiger E, Lefaucheur JP, Damy T. Prevalence and prognostic value of autonomic neuropathy assessed by Sudoscan® in transthyretin wild-type cardiac amyloidosis. ESC Heart Fail. 2021 Apr;8(2):1656-1665.
[2] Ozaki R, Cheung KK, Wu E, Kong A, Yang X, Lau E, Brunswick P, Calvet JH, Deslypere JP, Chan JC. A new tool to detect kidney disease in Chinese type 2 diabetes patients: comparison of EZSCAN with standard screening methods. Diabetes Technol Ther. 2011 Sep;13(9):937-43. doi: 10.1089/dia.2011.0023. Epub 2011 Jun 29. PMID: 21714678.
[3] Reach P, Touzot M, Lombardi Y, Maheas C, Sacco E, Fels A, Beaussier H, Ureña-Torres P, Chatellier G, Ridel C, Zuber M. Electrochemical skin conductance by Sudoscan®: a new tool to predict intradialytic hypotension. Nephrol Dial Transplant. 2021 Jul 23;36(8):1511-1518. doi: 10.1093/ndt/gfab183. PMID: 34021358; PMCID: PMC8311574.
[4] Touzot M, Reach P, Mobio A, Sacco E, Fels A, Beaussier H, Ureña-Torres P, Chatellier G, Ridel C, Zuber M. Association of Electrochemical Skin Conductance by Sudoscan and Cardiovascular Outcomes in Hemodialysis Patients. Kidney Int Rep. 2022 Sep 16;7(12):2734-2736. doi: 10.1016/j.ekir.2022.09.013. PMID: 36506235; PMCID: PMC9727515.
