Avaliação da associação entre as alterações no metabolismo mineral e o prurido nos pacientes em hemodiálise

Welter, Elisângela de Quevedo; Frainer, Renata Hubner; Maldotti, Adriana; Losekann, Alexandre; Weber, Magda Blessmann

doi:10.1590/s0365-05962011000100003

Cited by 20 publications

(13 citation statements)

References 28 publications

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“…Numerous studies have shown that disturbances in mineral metabolism such as calcium, phosphorus, and intact parathyroid hormone (iPTH) level are not related to itching in patients on hemodialysis [3,6,19,23,24,28,38,39]. According to the other reports, pruritus may be independently associated with higher calcium [18,20,35], phosphorus, and iPTH concentrations [40].…”

Section: Discussionmentioning

confidence: 99%

Substance P and intensity of pruritus in hemodialysis and peritoneal dialysis patients

et al. 2013

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BackgroundUremic pruritus is a common complication in patients undergoing dialysis. The pathophysiological mechanisms of pruritus in patients with end-stage renal disease remain unknown. Neuropeptides, including substance P, are postulated to play an important role in the pathogenesis of pruritus. The aim of this study was to evaluate the role of substance P in uremic pruritus in patients on hemodialysis and peritoneal dialysis.Material/MethodsWe included 197 patients with end-stage renal disease: 54 on continuous ambulatory peritoneal dialysis and 143 on hemodialysis. Substance P, calcium, phosphorus, iron, ferritin, CRP, albumin, hemoglobin, Ca × P product, and iPTH level were determined in all participants. The correlation between these parameters and self-reported itching was evaluated in patients on hemodialysis in comparison with peritoneal dialysis patients.ResultsThe incidence of itching was similar in hemodialysis and peritoneal dialysis patients. No differences in substance P level between the 2 groups were found. There was no correlation between substance P level and the incidence or intensity of pruritus in dialyzed patients.ConclusionsThis study demonstrates that substance P does not play any important role in pruritus in hemodialysed and peritoneal dialyzed patients. However, further studies are necessary to assess the exact role of neuropeptides in uremic pruritus.

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Section: Discussionmentioning

confidence: 99%

Substance P and intensity of pruritus in hemodialysis and peritoneal dialysis patients

et al. 2013

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“…Data are mixed regarding variables that associate with CKD-aP. Although markers of mineral metabolism 13 , 22 , 23 , 37 and dialysis efficiency 13 , 23 , 24 , 26 , 38 have historically been thought to associate with CKD-aP, many studies, including the most recent study of DOPPS, have challenged these findings. 3 , 39 A multivariate analysis of 6256 patients from DOPPS found no association between CKD-aP and phosphorus, calcium, calcium–phosphorus product, parathyroid hormone (PTH), Kt/V, or hemodiafiltration.…”

Section: Diagnosismentioning

confidence: 99%

CKD-Associated Pruritus: New Insights Into Diagnosis, Pathogenesis, and Management

Verduzco

Shirazian

2020

Kidney International Reports

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Chronic kidney disease-associated pruritus (CKD-aP) is a common, troubling and in some cases debilitating problem for patients with CKD and end-stage renal disease. Despite a prevalence rate of approximately 20% in CKD and 40% in end-stage renal disease, and a clear association with poorer psychosocial and medical outcomes, this condition is often underreported by patients and overlooked by health care providers. This is likely due, in part, to uncertainty regarding its pathogenesis and treatment. Most commonly, CKD-aP is attributed to toxin build-up, peripheral neuropathy, immune system dysregulation, or opioid dysregulation. Prior treatment studies of CKD-aP have targeted these potential etiologies but have been limited by noncontrolled design, small sample size, and non-uniform definitions of CKD-aP. Recently, several large, randomized controlled trials targeting opioid dysregulation have yielded promising results. These trials have spurred new hope for understanding and treating this condition.

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“…10 In addition to the DOPPS data, another 23 studies from 11 countries from 1973 to 2012 reported the incidence of pruritus in end-stage renal disease (ESRD) patients. 7,11–31 These data combined include 5,926 total independent dialysis patients, with a mean weighted prevalence of pruritus of 34.9%. Combining these data with the 13,300 patients in the DOPPS-I and DOPPS-II data 10 yields a total of 19,226 ESRD patients studied, with a mean weighted prevalence of pruritus of 40.6%.…”

Section: Epidemiologymentioning

confidence: 99%

“…Of the earlier-described prevalence studies, seven, including the DOPPS data, included an assessment of pruritus severity. 10,11,14,15,18,21,29 By combining these studies, the weighted mean prevalence of severe pruritus (including very much or extreme pruritus) was 24.5% among 16,672 dialysis patients. If the DOPPS data were excluded, the weighted mean prevalence of severe pruritus decreased somewhat to 22.5% among 3,372 patients.…”

Section: Epidemiologymentioning

confidence: 99%

Pruritus in Kidney Disease

Combs

Teixeira

Germain

2015

Seminars in Nephrology

124

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Summary Pruritus is a common and distressing symptom in patients with chronic kidney disease. The most recent epidemiologic data have suggested that approximately 40% of patients with end-stage renal disease experience moderate to severe pruritus and that uremic pruritus (UP) has a major clinical impact, being associated strongly with poor quality of life, impaired sleep, depression, and increased mortality. The pathogenesis of UP remains largely unclear, although several theories on etiologic or contributing factors have been proposed including increased systemic inflammation; abnormal serum parathyroid hormone, calcium, and phosphorus levels; an imbalance in opiate receptors; and a neuropathic process. UP can present somewhat variably, although it tends to affect large, discontinuous, but symmetric, areas of skin and to be most symptomatic at night. A variety of alternative systemic or dermatologic conditions should be considered, especially in patients with asymmetric pruritus or other atypical features. Treatment initially should focus on aggressive skin hydration, patient education on minimizing scratching, and optimization of the aspects of chronic kidney disease care that are most relevant to pruritus, including dialysis adequacy and serum parathyroid hormone, calcium, and phosphorus management. Data for therapy specifically for UP remain limited, although topical therapies, gabapentin, type B ultraviolet light phototherapy, acupuncture, and opioid-receptor modulators all may play a role.

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Avaliação da associação entre as alterações no metabolismo mineral e o prurido nos pacientes em hemodiálise

Cited by 20 publications

References 28 publications

Substance P and intensity of pruritus in hemodialysis and peritoneal dialysis patients

Substance P and intensity of pruritus in hemodialysis and peritoneal dialysis patients

CKD-Associated Pruritus: New Insights Into Diagnosis, Pathogenesis, and Management

Pruritus in Kidney Disease

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