Prevalence rate and influencing factors of uremic pruritus in hemodialysis patients in Anhui province / 安徽医科大学学报

Objective @#To explore the prevalence of uremic pruritus (UP) in patients with maintenance hemodialy sis (MHD) in Anhui Province and its influential factors .@*Methods @#Patients with MHD were enrolled in 27 hemo dialysis centers in Anhui Province . Clinical data were compared .@*Results @#A total of 3 025 patients with MHD were included . The prevalence of UP was 63.3% , among them , mild UP 55.9% and moderate to severe UP 7.4% . The prevalence rates of UP in southern Anhui , central Anhui and northern Anhui were 75.4% , 63.6% and 57.9% . The prevalence of total UP in ≤30 years , 31 - 50 years , 51 - 70 years and ≥71 years was 53.5% ,59.8% , 65.4% and 65.9% . The prevalence of total UP and moderate to severe UP increased with age ( P < 0.01) . Age , age of dialysis , proportion of hypertension , 25(hydroxy) vitamin D3 [25(OH)D3 ] , proportion of low flux dialyzer usage and proportion of calcium phosphorus binder usage in UP group were higher than those in the group without UP. However , the levels of diastolic blood pressure , hemoglobin ( Hb) and hemodialysis filtration ratio in the UP group were lower than those in the non UP group (P < 0.05) . By comparison , the age , hyperten sion and diabetes of patients in moderate and severe UP group were higher than those in mild UP group , while the proportion of non calcium phosphorus binding was lower than that in mild UP group ( P < 0.05) . Binary Logistic regression analysis showed that high 25(OH)D3 was associated with a higher risk of UP in MHD patients , and high throughput dialyzer use was associated with a lower risk of UP in MHD patients ( P < 0.05) .@*Conclusion @#The prevalence rate of UP in maintenance hemodialysis patients in Anhui province is 63.3% . The prevalence of UP is the highest in southern Anhui , and the prevalence of total UP and moderate to severe UP increases with age . High 25(OH)D3 levels are a risk factor for UP in MHD patients , and the use of high throughput dialyzers can reduce the risk of UP in MHD patients .

Efficacy and safety of turmeric 1% emollient cream in the control of chronic kidney disease-associated pruritus in Hemodialysis patients: A randomized double-blind clinical trial

Introduction@#Chronic kidney disease-associated pruritus (CKD-aP) remains a frequent and distressing symptom in hemodialysis patients, fur- ther compromising their quality of life. Turmeric, or Curcuma longa, is a naturally-occurring, widely available product that inhibits major inflamma- tory mechanisms associated with CKD-aP.@*Objectives@#This study aimed to determine the efficacy and safety of turmeric 1% emollient cream versus a bland emollient in the reduction of chronic kidney disease-associated pruritus in hemodialysis patients.@*Methods@#This study was a randomized, double-blind, controlled trial of the effect of turmeric 1% cream in the reduction of chronic kidney disease associated pruritus in hemodialysis patients compared to a bland emollient. The main outcome measure was the proportion of subjects who demonstrated response to treatment, as well as the incidence of adverse effects.@*Results@#Intention to treat analysis on 106 patients, 53 assigned to turmeric 1% cream and 53 to bland emollient cream, was done. There was a sig- nificant difference (P=0.03) in the proportion of patients who achieved treatment success between the turmeric group (66%) and bland emollient group (45%). The mean decrease in pruritus score (VAS) of the group treated with turmeric was significantly greater than that of the bland emol- lient group (P=0.018). No adverse effects were noted in both groups.@*Conclusion@#Among hemodialysis patients diagnosed with CKD-aP, topical application of turmeric 1% cream twice daily for four weeks was supe- rior to that of bland emollient cream based on efficacy and safety outcome measures.

Investigation of pruritus in hemodialysis patients and its influencing factors / 医学研究生学报

Objective Uremia pruritus (UP) can range from itching to local itching affecting the back, face and arms, and its intensity is related to a variety of health-related quality of life. The article aimed to investigate the current status of UP in hemodialysis patients and provide reference for the treatment and care of pruritus. Methods Using the four-item itch scale (FIIQ scale) and visual analogue scale (VAS), 212 patients with maintenance hemodialysis treated in our hospital from July 2018 to February 2019 were divided into two groups according to the presence or absence of UP: 138 patients in pruritus group and 74 patients in non-pruritus group. The differences in basic demographic data, relevant laboratory examination indexes, sleep, anxiety and depression were compared between the two groups, and the relevant influencing factors were analyzed. Results The total score for pruritus was (7.44±4.35)points, which was at moderate pruritus level. PTH (469.57±110.69) pg/mL and total sleep score (10.73±2.01) in pruritus group were higher than those in non-pruritus group [(368.05±50.35) pg/mL, (6.19±1.96) points], the difference was statistically significant (P < 0.05). Total depression score in pruritus group was also higher than those without pruritus (P < 0.05). Logistic regression showed that sleep and depressive symptoms were the influencing factors of skin itching (P<0.05). Conclusion Maintenance hemodialysis patients have a high incidence of UP, and their sleep and depressive symptoms are related to UP. Nursing staff should make a comprehensive evaluation according to the influencing factors and take corresponding measures to reduce pruritus and the occurrence of complications in order to improve the quality of life of patients.

Comparison of uremic pruritus between patients undergoing hemodialysis and peritoneal dialysis

BACKGROUND: Uremic pruritus is a common, but unpleasant, complication of end-stage renal disease. The uremic burden may differ between hemodialysis (HD) and peritoneal dialysis (PD) patients. This difference may also change the clinical characteristics of uremic pruritus between the 2 modalities. In this study, we investigated the uremic pruritus between patients on HD and PD. METHODS: A total of 425 HD and 223 PD patients from the Clinical Research Center registry in Korea were included. Patients were assessed for pruritus intensity, scratching activity, pruritus distribution, and frequency of pruritus-related sleep disturbance using the visual analog scale and questionnaire. RESULTS: The prevalence of uremic pruritus was higher in PD patients than that in HD patients (62.6% vs. 48.3%, P = 0.001). In the multivariable logistic analysis, PD treatment was significantly associated with the prevalence of uremic pruritus (odds ratio, 1.76; 95% confidence interval, 1.20-2.57, P = 0.004) after adjustment for clinical variables. The visual analog scale score, representing a subjective intensity of itchiness, was significantly higher in PD patients (PD 2.11 ± 2.32 vs. HD 1.65 ± 2.28, P = 0.013) compared with HD patients. The intensity of uremic pruritus was independently related with serum albumin levels (β = -0.143, P = 0.006) in HD patients and total weekly Kt/V (β = -0.176, P = 0.028) in PD patients. CONCLUSION: Our data demonstrate the difference in prevalence, intensity, and risk factors of uremic pruritus between HD and PD patients. These findings suggest that careful consideration for uremic pruritus might be needed in end-stage renal disease patients according to the dialysis modality.

Clinical Efficacy and Mechanism Study on Lactulose Enema Intervention to MHD with UP / 世界科学技术-中医药现代化

This article was aimed to discuss the mechanism of lactulose enema therapy to improve efficiency among maintenance hemodialysis (MHD) patients with uremic pruritus (UP) from the intervention of parathyroid hormone (PTH) and micro-inflammation state. A total of 60 cases of chronic kidney disease (CKD) stage 5, MHD patients with UP were randomly divided into 3 groups according to different intervention methods, which were the control group, loratadine and lactulose group. The integration of kidney disease treatment was adopted in the control group. In the loratadine group, on the basis of the control group medication, oral administration of loratadine, 10 mg/time, once a day, was combined. In the lactulose group, on the basis of the control group medication, lactulose enema, 30 mg/time, twice a day, was combined for 30 days. The pretreatment and posttreatment clinical curative effects were e-valuated among patients from 3 groups. Observation was also made on their itchy visual analogue scale (VAS) and serum PTH, high-sensitivity c-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6) lev-el, respectively. The results showed that there were significant improvements on VAS, PTH and inflammation indexes (i.e., hs-CRP, TNF-α, IL-6) before and after treatment (P< 0.05 or P< 0.01). Compared to the control group, the posttreatment clinical total curative effects were significantly increased in both the loratadine group and lactulose group (P< 0.05); VAS, PTH and inflammation indexes (i.e., hs-CRP, TNF-α, IL-6) were significantly decreased (P< 0.05). There was no statistical difference of indexes mentioned above in the loratadine group and lactulose group. It was concluded that lactulose enema therapy improve PTH and micro-inflammation state among MHD patients with UP. It is one of the mechanisms to relieve skin itching.

A Clinical Study on Uremic Pruritus in Hemodialysis Patients / 대한피부과학회지

BACKGROUND: Uremic pruritus is a common disabling problem in patients with end-stage renal disease (ESRD). Not many studies have focused on evaluating the clinical characteristics of uremic pruritus. OBJECTIVE: The aim of this study was to identify the prevalence and clinical characteristics of uremic pruritus in hemodialysis patients. METHODS: A detailed questionnaire was used to evaluate the pruritus of 75 patients who were treated at the hemodialysis unit in Maryknoll Medical Center. We examined the relationship of the quality of dialysis and various factors and medical parameters with uremic pruritus. RESULTS: Pruritus was a common symptom in the study population. Twenty two point seven percent of the patients had severe pruritus in the past, and 36% were affected by it at the time of the study. There was no correlation between the occurrence of pruritus and the demographic or medical parameters of the patients (gender, age, the cause of ESRD, the duration of ESRD and hemodialysis, previous treatment of ESRD, the dialysis efficacy as expressed by Kt/V, and the transfusion and laboratory parameters such as blood urea nitrogen, creatinine, calcium, phosphorus, parathyroid hormone and uric acid). Skin dryness was found in 14 (18.7%) patients. It was assessed as slightly dry skin in 9 (12.0%) patients and as rough skin in 5 (6.7%) patients. A significant relationship was demonstrated between the intensity of xerosis and the frequency of uremic pruritus (p=0.042). The intensity of xerosis was greater in the severe pruritic patients, but any statistically significant correlation was not found. The major factors found to exacerbate pruritus included sleep disturbance, heat, dry skin and dialysis. The major factors found to reduce pruritus included taking a shower or bath, sleeping, dialysis and physical activity. CONCLUSION: There was a significant relationship between the intensity of xerosis and the frequency of uremic pruritus. A better understanding of the clinical characteristics of uremic pruritus will afford clinicians the necessary elementary tools to discover its origin and the possible effective treatments.

Clinical Characteristics of Uremic Pruritus in Chronic Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: Pruritus is a common, unpleasant symptom in patients on maintenance hemodialysis (HD), however its pathogenesis remains unclear. The aim of this study was to evaluate the prevalence of pruritus in chronic renal failure patients on hemodialysis and to correlate its presence with several clinical and laboratory parameters. METHODS: One hundred seventy patients on maintenance HD were enrolled, Some relevant clinical and laboratory parameters (age, sex, duration of dialysis, type of membrane, underlying renal disease, medications, erythropoietin (EPO) and laboratory findings including hematocrit, creatinine, urea, calcium, phosphorus, parathyroid hormone (PTH), erythrocyte sediment rate (ESR), albumin, beta2-microglobulin (beta2MG) and lipid profile as well as parameters of adequate dialysis (Kt/Vurea, URR) were evaluated. RESULTS: Total 170 patients (80 males) were enrolled and pruritus was found in 60 patients (Group I, M:F=29:31). One hundred ten patients did not complain pruritus (Group II, M:F=51:59). Mean age was significantly higher in Group I (59.6+/-14.8 vs. 54.3+/-13.6 years, p<0.05). There was no difference in sex, type of membrane, primary renal disease, serum beta2MG, ESR, EPO dose, duration of dialysis and serum albumin level. The mean value of Kt/V was higher in Group II (1.39+/- 0.36 vs. 1.51+/-0.27, p<0.035). CONCLUSION: Pruritus was more common in older patients and low Kt/V, but other clinical characteristics and laboratory findings were not correlated with uremic pruritus.

Clinical Characteristics of Uremic Pruritus in Chronic Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: Pruritus is a common, unpleasant symptom in patients on maintenance hemodialysis (HD), however its pathogenesis remains unclear. The aim of this study was to evaluate the prevalence of pruritus in chronic renal failure patients on hemodialysis and to correlate its presence with several clinical and laboratory parameters. METHODS: One hundred seventy patients on maintenance HD were enrolled, Some relevant clinical and laboratory parameters (age, sex, duration of dialysis, type of membrane, underlying renal disease, medications, erythropoietin (EPO) and laboratory findings including hematocrit, creatinine, urea, calcium, phosphorus, parathyroid hormone (PTH), erythrocyte sediment rate (ESR), albumin, beta2-microglobulin (beta2MG) and lipid profile as well as parameters of adequate dialysis (Kt/Vurea, URR) were evaluated. RESULTS: Total 170 patients (80 males) were enrolled and pruritus was found in 60 patients (Group I, M:F=29:31). One hundred ten patients did not complain pruritus (Group II, M:F=51:59). Mean age was significantly higher in Group I (59.6+/-14.8 vs. 54.3+/-13.6 years, p<0.05). There was no difference in sex, type of membrane, primary renal disease, serum beta2MG, ESR, EPO dose, duration of dialysis and serum albumin level. The mean value of Kt/V was higher in Group II (1.39+/- 0.36 vs. 1.51+/-0.27, p<0.035). CONCLUSION: Pruritus was more common in older patients and low Kt/V, but other clinical characteristics and laboratory findings were not correlated with uremic pruritus.

Six cases of uremic pruritus treated with emollient and UVB / 대한피부과학회지

Phototherapy with UVB has become a cornerstone in treating uremic pruritus. To investigate the additional benefit of emollient, we performed emollien-phototherapy in six uremic pruritus patients on hemodialysis, one of which was not responding with UVB only. After applying mineral oil over the whole body, UVB phototh.rapy was performed two to three times weekly. Improvement was noted within one to three treatments and after three to ten treatments, pruritus markedly or totally disappeared in al six patients. This result suggests that emollient-phototherapy is as effective as, or in some patients, more effective than phototherapy with UVB only in managing uemic pruritus.