Risk of Skin Diseases in Maintenance Hemodialysis.

INTRODUCTION: Maintenance hemodialysis (HD) patients are potential transplant recipients. One of the most common cancers in the population of kidney recipients is skin neoplasm. Skin infections are also of a particular importance. In this population, especially in patients on the transplant waiting list, full dermatological examination, including dermatoscopy, should be carried out routinely. MATERIALS AND METHODS: The research was comprised of 105 HD patients (57 men, 48 women) with a mean age of 60.8 (range 25-94) years. The patients' skin condition was assessed and a dermatoscopic examination was performed. We compared the incidence of skin diseases in the two subpopulations: HD patients (n = 89) and HD patients active on the transplant waiting list (n = 16). RESULTS: Bacterial, fungal, and viral infections in the group of HD patients occurred in 24.7%, 14.6%, and 6.7% of patients, respectively. In HD patients on the waiting list, bacterial skin diseases were reported in 12.5% of patients, and neither fungal nor viral infections were noticed. Malignant skin lesions and precancerous conditions, such as basal cell carcinoma and keratosis actinic, developed in 4.5% and 3.4% of the HD patients. These malignancies did not occur in HD patients on the waiting list. The results show proper qualification for transplantation in maintenance HD patients before the waiting list. In the group of dialysis patients, 67.4% required dermatological care, while in the HD waiting group only 12.5% required dermatological care. CONCLUSIONS: The presented results prove the necessity of performing dermatological examinations on HD patients. Some dermatological skin lesions, if not diagnosed and treated, could progress to cancer after organ transplantation.

Level of Education and Knowledge of Skin Cancer Risk Factors in Patients Undergoing Maintenance Hemodialysis.

INTRODUCTION: An increased risk of skin cancer is particularly important in patients undergoing maintenance hemodialysis (HD), who are potential transplant recipients. In transplant recipients who are exposed to immunosuppressive therapy, neoplastic skin disease my take a more aggressive course. Increased exposure to photoradiation, elderly age, a low skin phototype, sunburn during childhood, and a history of smoking are the main factors contributing to the development of skin neoplasms. Knowledge of these risk factors as well as education on sun protection should be important for such patients. PATIENTS AND METHODS: We studied 105 HD patients (57 men, 48 women) with a mean age of 60.8 (range 25-94) years. Knowledge of skin cancer risk factors was assessed on the basis of a questionnaire regarding skin cancer risk factors. RESULTS: In the study group, 23.8% of patients claimed that they frequently and intensively engage in sunlight exposure. However, only 11.4% have started to apply sunblockers recently. Sunburn during adolescence was reported by 12.4% patients. Among the patients studied, 65.7% had skin phototype I or II, and only 34.3% had phototype III. In the investigated study group, 55.2% admitted smoking: 30.5% smoked more than 20 pack-years. Among the patients studied only 2.86% could name 3 skin cancer risk factors, 29.5% 2 risk factors, 60% 1 risk factor, and 7.6% could not name any risk factor. CONCLUSIONS: The results presented prove that patients undergoing HD lack knowledge regarding skin cancer risk factors, which explains the necessity of education, particularly on the dangers of sun radiation.

Do Patients With End-Stage Chronic Renal Failure Treated With the Use of Hemodialysis Have Healthy Skin? Evaluation of Skin Lesions and Basic Education About Risk Factors for Skin Cancer in This Patient Population.

BACKGROUND: Considering the increasing incidence of skin cancers in patients after renal transplantation, evaluation of skin condition in dialysis patients, from whom kidney transplant recipients are recruited, appears to be very important. Particular importance is attached to the identification of such dialysis patients in the population who require dermatologic care before qualifying for transplantation. The objective of this study was to determine the prevalence of skin diseases in the dialysis patient population. Education of the patients regarding risk factors for skin cancer and the need for sun protection was performed. METHODS: Full dermatologic examination, including dermatoscopy, was performed on a group of 77 dialysis patients (38 women, 39 men) and a control group of 77 healthy people (60 women, 17 men). RESULTS: Eight hemodialysis patients had healthy skin compared with 33 people from the control group. In the remaining hemodialysis patients, the following skin lesions were observed: 1) inflammatory and allergic skin disorders in 17 patients; 2) bacterial, fungal, and viral infections in 26 patients; 3) benign lesions in 39 patients; 4) malignant skin lesions and precancerous conditions in 4 patients; and 5) other skin changes in 63 patients. CONCLUSIONS: Skin lesions are common in the dialysis patient population. Only 10% of the examined population had completely healthy skin, compared with 43% of the control group. More than one-half of dialysis patients required dermatologic care compared with one-third of healthy control subjects.