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2024, Number 4

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Rev Nefrol Dial Traspl 2024; 44 (4)

Uremic pruritus and associated factors in chronic hemodialysis patients: past and current experience

Cömert E, Yesilova A, Koçak G, Çelik AV, Yavuz H, Erdoğan N

Language: English
References: 21
Page: 190-196
PDF size: 354.41 Kb.


ABSTRACT

Introduction: Uremic pruritus (UP) is a prevalent but overlooked problem in chronic kidney disease (CKD). This study aimed to investigate the prevalence of UP in chronic dialysis patients and its correlation with demographic, clinical, and biochemical parameters. Methods: The study included all patients ›18 years of age who had undergone hemodialysis three days a week for at least six months and agreed to participate. Pregnant women and patients with a history of steroid use, malignancy, chronic liver or biliary tract disease, and dermatological disease were excluded from the study. Pruritus severity was evaluated using the Visual Analog Scale (VAS) and the 5-D Itch Scale. Results: Of 1093 patients, 582 (53.25%) were male, and 511 (46.75%) were female, with a mean age of 62.39±14.27 years. The results showed that 224 (20.5%) patients had UP, with a strong positive correlation between VAS and the 5-D Itch Scale in the pruritus group (r=0.883, p=0.0001). C-reactive protein (CRP) levels were significantly increased, and Kt/V and urea reduction rate (URR) levels significantly decreased in UP patients. In addition, we showed that hypertension, high CRP, and low URR were risk factors affecting UP (p: 0.037, p: 0.048, and p: 0.011, respectively). Grouping patients by pruritus severity as mild, moderate, and severe revealed no significant difference between the groups, except for the significantly lower mean age in the severe pruritus group (p=0.003). Conclusions: The correlation between UP and CRP supported the immune hypothesis in the pathogenesis of UP. Moreover, increasing the dialysis dose may be beneficial in mitigating UP symptoms, even in patients with normal Kt/V and URR levels.


REFERENCES

  1. Hiroshige K, Kabashima N, Takasugi M, KuroiwaA. Optimal dialysis improves uremic pruritus. Am JKidney Dis. 1995;25:413-9.

  2. Cho YL, Liu HN, Huang TP, Tarng DC. Uremicpruritus: roles of parathyroid hormone and substanceP. J Am Acad Dermatol. 1997;36:538-43.

  3. Reich A, Heisig M, Phan NQ, Taneda K, Takamori K,Takeuchi S, Furue M, Bloma C, Augustin M, StanderS, Szepietowski JC. Visual analogue scale: evaluationof the instrument for the assessment of pruritus. ActaDerm Venereol. 2012;92:497-501.

  4. Pereira MP, Ständer S. Assessment of severity andburden of pruritus. Allergol Int. 2017;66:3-7.

  5. Elman S, Hynan LS, Gabriel V, Mayo MJ. The 5-D itchscale: a new measure of pruritus. Br J Dermatol. 2010Mar;162(3):587-93.

  6. Pisoni RL, Wikström B, Elder SJ, et al. Pruritus inhemodialysis patients: International results fromthe Dialysis Outcomes and Practice Patterns Study(DOPPS). Nephrol Dial Transplant 2006;21:3495.

  7. Rayner HC, Larkina M, Wang M, Graham-Brown M,van der Veer SN, Ecder T, Hasegawa T, KleophasW, Bieber BA, Tentori F, Robinson BM, Pisoni RL.International comparisons of prevalence, awarenessand treatment of pruritus in people on hemodialysis.Clin J Am Soc Nephrol 2017;12:2000.

  8. Ramakrishnan K, Bond TC, Claxton A, SoodVC, Kootsikas M, Agnese W, Sibbel S. Clinicalcharacteristics and outcomes of end-stage renaldisease patients with self-reported pruritus symptoms.Int J Nephrol Renovasc Dis. 2013;7:1-12.

  9. Virga G, Visentin I, La Milia V, Bonadonna A.Inflammation and pruritus in haemodialysis patients.Nephrol Dial Transplant. 2002 Dec;17(12):2164-9.

  10. Zhao JH, Zhu QS, Li YW, Wang LL. Determinantsof the intensity of uremic pruritus in patients receivingmaintenance hemodialysis: A cross-sectional study.PLoS One. 2021 Jan 20;16(1):e0245370.

  11. Chen HY, Chiu YL, Hsu SP, Pai MF, Lai CF, Yang JY,Peng YS, Tsai TJ, Wu KD. Elevated C-reactive proteinlevel in hemodialysis patients with moderate/severeuremic pruritus: a potential mediator of high overallmortality. QJM. 2010 Nov;103(11):837-46.

  12. Silva SR, Viana PC, Lugon NV, Hoette M, Ruzany F,Lugon JR. Thalidomide for the treatment of uremicpruritus: a crossover randomized double-blind trial.Nephron. 1994;67(3):270-3.

  13. Gilchrest BA, Rowe JW, Brown RS, SteinmanTI, Arndt KA. Ultraviolet phototherapy of uremicpruritus. Long-term results and possible mechanismof action. Ann Intern Med. 1979 Jul;91(1):17-21.

  14. Kuypers DR, Claes K, Evenepoel P, Maes B,Vanrenterghem Y. A prospective proof of conceptstudy of the efficacy of tacrolimus ointment onuraemic pruritus (UP) in patients on chronic dialysistherapy. Nephrol Dial Transplant. 2004;19:1895-901.

  15. Masi CM, Cohen EP. Dialysis efficacy and itching inrenal failure. Nephron. 1992; 62:257.

  16. Ko MJ, Wu HY, Chen HY, Chiu YL, Hsu SP, PaiMF, Yehyang J, Lai CF, Lu HM, Huang SC, Yang SY,Wen SY, Chiu HC, Hu CF, Peng YS, Jee SH. Uremicpruritus, dialysis adequacy, and metabolic profiles inhemodialysis patients: a prospective 5-year cohortstudy. PLoS One. 2013;8:e71404.

  17. Duque MI, Thevarajah S, Chan YH, Tuttle AB,Freedman BI, Yosipovitch G. Uremic pruritus isassociated with higher kt/V and serum calciumconcentration. Clin Nephrol. 2006;66:184.

  18. Momose A, Kudo S, Sato M, Saito H, Nagai K,Katabira Y, Funyu T. Calcium ions are abnormallydistributed in the skin of haemodialysis patientswith uraemic pruritus. Nephrol Dial Transplant. 2004Aug;19(8):2061-6.

  19. Akhyani M, Ganji MR, Samadi N, Khamesan B,Daneshpazhooh M. Pruritus in hemodialysis patients.BMC Dermatol. 2005 Jun 24;5:7.

  20. Shirazian S, Kline M, Sakhiya V, Schanler M,Moledina D, Patel C, Hazzan A, Fishbane S.Longitudinal predictors of uremic pruritus. J Ren Nutr.2013 Nov;23(6):428-31.

  21. Chou FF, Ho JC, Huang SC, Sheen-Chen SM. A studyon pruritus after parathyroidectomy for secondaryhyperparathyroidism. J Am Coll Surg. 2000; 190:6




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