Risk factors of skin pruritus in peritoneal dialysis patients and intervention with individualized care / 中国实用护理杂志

ABSTRACT

Objective:To explore risk factors of skin pruritus in peritoneal dialysis patients and the effect of individualized care intervention, to provide guidance for clinical practice.Methods:The total of 87 patients with peritoneal dialysis who were followed-up with pruritus in the Beijing Anzhen Hospital from January 2017 to June 2020 were selected. The Visual Analogue Scale (VAS) was used to evaluate the degree of pruritus, and the patients were divided into two groups mild-to-moderate skin pruritus group (VAS≤6 points) and severe skin pruritus group (VAS>6 points). The risk factors of severe skin pruritus were analyzed by single factor and multivariate Logistic regression. The improvement of skin pruritus after 3 months of individualized nursing intervention was observed.Results:Among the 87 patients, the mild-to-moderate skin pruritus group and the severe skin pruritus group accounted for 64.4%(56/87) and 35.6%(31/87), respectively. Single factor analysis showed that the age, prevalence of diabetes, serum albumin, serum phosphorus, intact parathyroid hormone and C-reactive protein levels were (61.8 ± 11.5) years old, 33.3%(19/56), (36.3 ± 5.3) g/L, (1.6 ± 0.5) mmol/L, 328.4(144.9, 494.5) ng/L, 2.8(0.6, 8.3) ng/L in the mild-to-moderate skin pruritus group, and (67.0 ± 9.2) years old, 61.1%(19/31), (33.9 ± 4.8) g/L, (1.9 ± 0.3) mmol/L, 397.0(300.0,758.6) ng/L, 7.2(2.6, 17.2) mg/L in the severe skin pruritus group, the differences were significant between the two groups ( t values were -2.17, 2.14, -2.32, Z values were -2.28, -2.90, χ 2 value was 6.07, P<0.05). Logistic multivariate regression analysis showed that low albumin, high blood phosphorus and high C-reactive protein were independent risk factors for severe skin pruritus in peritoneal dialysis patients ( P<0.05). After 3 months of individualized care,18.4% (16/87) patients had complete remission,19.5% (17/87) patients significantly relieved, 55.2% (48/87) relieved, 6.9% (6/87) were ineffective, and the total response rate was 93.1%(81/87). Conclusions:More than one-third of peritoneal dialysis patients with pruritus are severe. Lower serum albumin, higher serum phosphorus and higher C-reactive protein are independent risk factors for severe pruritus in peritoneal dialysis patients. Individualized care can effectively improve pruritus in peritoneal dialysis patients.