From the Guidelines
Uremia is not directly associated with facial twitching, as it is not listed among the signs and symptoms of uremia in the 2015 update of the KDOQI clinical practice guideline for hemodialysis adequacy [1@]. The guideline highlights various signs and symptoms associated with uremia, including seizures, amenorrhea, reduced core body temperature, protein-energy wasting, insulin resistance, heightened catabolism, serositis, hiccups, platelet dysfunction, and somnolence [@1@]. However, facial twitching is not mentioned as a specific symptom of uremia.
Key Points to Consider
- Uremia is a nonspecific constellation of symptoms and signs superimposed on a low GFR, and its symptoms can have other causes [@1@].
- The decision to initiate maintenance dialysis should be based upon an assessment of signs and/or symptoms associated with uremia, but providers need to be aware of uremia "mimickers," especially in the elderly and those receiving poly-pharmacy [@1@].
- While uremic toxins can interfere with normal neuromuscular transmission, causing various neuromuscular symptoms, facial twitching is not explicitly mentioned as a symptom of uremia in the guideline [@1@].
Clinical Implications
- Patients with advanced kidney disease or end-stage renal disease should be monitored for signs and symptoms of uremia, but facial twitching should not be solely attributed to uremia without considering other potential causes [@1@].
- Treatment of uremia focuses on addressing the underlying kidney dysfunction through dialysis, medication management to correct electrolyte imbalances, and potentially kidney transplantation in severe cases [@1
From the Research
Uremia and Facial Twitching
- There is no direct evidence to suggest that uremia causes facial twitching 1, 2, 3, 4, 5.
- However, uremia has been associated with various neurological symptoms, including paresthesia, which is a tingling or numbness sensation in the skin 4.
- Secondary hyperparathyroidism, a common complication of uremia, can cause bone and joint pain, as well as facial deformities 1, 2.
- Facial changes in adult uremic patients on chronic dialysis have been reported, including enlarged facial volumes and altered facial structures 2.
- Uremic patients may experience a range of symptoms, including fatigue, anorexia, pruritus, nausea, and pain, which can affect their quality of life 4.