Purpose: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy with substantially higher complications among patients undergoing long-term hemodialysis (HD). Although carpal tunnel release (CTR) is the standard surgical treatment for CTS, outcomes may differ among patients undergoing long-term HD. The primary aim of this systematic review is to evaluate the postoperative outcomes of CTR in relation to duration of HD.

Methods: A systematic review was conducted by screening 569 studies. Variables included symptomatic relief, duration of HD prior to CTS diagnosis, duration of symptomatic CTS, and total duration of HD therapy prior to surgical intervention. Post-operative outcomes and complications at 12 months were also collected. Studies including patients receiving peritoneal dialysis, or had non-HD associated CTS, and case series with fewer than 10 patients were excluded. 

Results: Four studies were included, consisting of 199 HD patients (271 hands). Average follow-up was 26.9 months, ranging from 11.7 to 44.3 months. Generally, individuals with longer pre-diagnosis HD durations reported reduced symptomatic relief when compared to those with shorter durations. Complications 12 months after CTR occurred in 31 hands (11.4%). The most common complication was recurrent CTS symptoms in 25 hands (9.2%), followed by stiffness in 4 hands (1.5%) and delayed wound healing in 2 hands (0.7%). Specific timelines were reported by only one study with complications diagnosed at 12 months follow-up. Revision surgeries typically took place 15–21 months after initial CTR. Patients who underwent initial CTR more than two years after symptom onset had poor outcomes, with functional impairment reported 24 months after surgery. 

Conclusions: CTR generally improves symptoms and function in HD patients with CTS. However, longer HD duration prior to diagnosis and surgical intervention correlates with higher risk of recurrent symptoms and revision surgery. These findings highlight the importance of early diagnosis and timely surgical intervention in patients with HD to optimize clinical outcomes.