Association between uremic pruritus and long-term outcomes in patients undergoing dialysis

Ting, Sze-Wen; Fan, Pei‐Chun; Lin, Yu‐Sheng; Lin, Ming‐Shyan; Lee, Cheng‐Chia; Kuo, George; Chang, Chih‐Hsiang

doi:10.1016/j.jaad.2020.01.011

Cited by 9 publications

(10 citation statements)

References 5 publications

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“…UP is not an uncommon problem among dialysis patients and impairs quality of life [ 2 – 4 ]. In our previous study, UP is associated with increased all-cause mortality, infection-related death, and CV death [ 13 ]. Pisoni et al reported an increased mortality risk with severe pruritus, but this risk diminished after adjusting for sleep quality [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…UP not only negatively affects quality of life, sleep, and mood but may also contribute to worse long-term outcomes [ 2 – 4 ]. Our group reported that UP is associated with increased all-cause mortality, cardiovascular (CV) death and infection-related death [ 13 ]. In the current study, we further investigate the influence of UP on various types of long-term morbidities after starting dialysis therapy and also performed subgroup analysis on prespecified subgroups in the dialysis population by using Taiwan’s nationwide population-based database.…”

Section: Introductionmentioning

confidence: 99%

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Uremic pruritus and long-term morbidities in the dialysis population

et al. 2020

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Background Uremic pruritus (UP) is a multifactorial problem that contributes to low quality of life in dialysis patients. The long-term influences of UP on dialysis patients are still poorly understood. This study aims to elucidate the contribution of UP to long-term outcomes. Materials and method We used the Taiwan National Health Insurance Research Database to conduct this study. Patients on chronic dialysis were included and divided into UP and non-UP groups according to the long-term prescription of antihistamine in the absence of other indications. The outcomes include infection-related hospitalization, catheter-related infection, major adverse cardiac and cerebrovascular events (MACCE) and parathyroidectomy. Results After propensity score matching, 14,760 patients with UP and 29,520 patients without UP were eligible for analysis. After a mean follow-up of 5 years, we found that infection-related hospitalization, MACCE, catheter-related infection, heart failure and parathyroidectomy were all slightly higher in the UP than non-UP group (hazard ratio: 1.18 [1.16–1.21], 1.05 [1.01–1.09], 1.16 [1.12–1.21], 1.08 [1.01–1.16] and 1.10 [1.01–1.20], respectively). Subgroup analysis revealed that the increased risk of adverse events by UP was generally more apparent in younger patients and patients who underwent peritoneal dialysis. Conclusion UP may be significantly associated with an increased risk of long-term morbidities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Uremic pruritus and long-term morbidities in the dialysis population

et al. 2020

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“…Uremic pruritus (UP) is a common and troublesome complication seen in dialysis patients; it affects the quality of life in about 40% of these patients ( Mettang and Kremer, 2015 ). A previous cohort study revealed an association between UP and poor outcomes in dialysis patients, including overall mortality and infection-related death ( Ting et al, 2020 ). Hence, adequate control of UP is necessary for dialysis patients ( Ko et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy of Chinese herbal medicines for dialysis patients with uremic pruritus: A systematic review and network meta-analysis

Lai

Chiu

et al. 2023

Front. Pharmacol.

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Introduction: Uremic pruritus is common in dialysis patients and reduces their quality of life. Chinese herbal medicine has been effective in patients with this condition.Methods: We conducted a random-effects network meta-analysis to compare the efficacies of different Chinese herbal medicine treatments for uremic pruritus. Outcome measures including the overall effective rates, visual analog scale scores, C-reactive protein levels, and adverse drug reactions were analyzed.Results: The network meta-analysis retrieved 25 randomized controlled trials. Compared with conventional treatments alone, combination treatments with Xiao-Yang-Ke-Li was the most effective intervention in decreasing visual analog scale scores (mean difference −2.98, 95% mean difference −5.05 to −0.91) and levels of C-reactive protein (mean difference −5.01, 95% mean difference −7.27 to −2.75). Conventional treatment combined with Si-Wu Tang was superior to other therapeutic combinations when overall effective rates were determined. The best visual analog scale scores and overall effective rates were achieved by adjunctive treatment with the Touxie-Jiedu-Zhiyang decoction followed by uremic clearance granules; these treatments were the most beneficial for uremic pruritis.Conclusion: Our network meta-analysis provided the relative efficacies of different adjunctive Chinese herbal formulas. Adjunctive treatment with the Touxie-Jiedu-Zhiyang decoction was the best treatment for improving overall effective rates and reducing visual analog scores of uremic pruritus in dialysis patients.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=357656; Identifier: CRD42022357656.

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“…[3][4][5] Severe pruritus not only affects patients' quality of life but also increases all-cause and infection-related mortality in uremic maintenance HD, which significantly affects patients' long-term prognosis. 6 Currently, it is believed that the mechanism of pruritus in uremia is related to the deposition of macromolecular weight toxins in uremia, immune system disorder, peripheral neuropathy, and opioid imbalance. 7 Although new drugs are being developed to ameliorate peripheral neuropathy in patients, and methods of hemodiafiltration and hemoperfusion are being used to remove large and medium molecular weight toxins in patients with uremia, the results of treatment for itchy skin in patients with uremia undergoing chronic dialysis remain unsatisfactory.…”

Section: Introductionmentioning

confidence: 99%

Early clinical observation of supra‐hemodiafiltration with endogenous reinfusion in the treatment of uremic pruritus

Zha

Shi

et al. 2023

Artificial Organs

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BackgroundTo evaluate the clinical efficacy of supra‐hemodiafiltration with endogenous reinfusion (Supra‐HFR) for pruritus in uremic maintenance hemodialysis (HD) patients and explore the possible mechanism.MethodsThis study prospectively included 60 patients with uremia who underwent maintenance hemodialysis and developed pruritus. Patients were randomly divided into a study group (30 cases) and a control group (30 cases). Patients in the study group underwent dialysis once a week with Supra‐HFR and twice a week with HD. The group received HD dialysis 3 times a week. Visual analog scales (VAS) scores, 5‐D itch scale scores, and 12‐Item Pruritus Severity Scale (12‐PSS) were used to evaluate the itching degree of patients. Quality of life was assessed using KDTA and SF‐36 scores. Blood levels of hypersensitive C‐reactive protein, calcium ion (Ca2+), phosphorus ion (P3+), free parathyroid hormone (iPTH), and β2‐microglobulin (β2‐MG) were compared between the two groups before treatment and at follow‐up 24 weeks after treatment.ResultsBefore treatment, there was no significant difference in VAS, 5‐D itch scale, and 12‐PSS score between the study group and the control group (all p > 0.05). After 24 weeks of treatment, the VAS score of the study group (2.82 ± 0.91) was significantly lower than that of the control group (7.47 ± 1.32, p < 0.001), the 5‐D itch scale score of the study group (9.47 ± 2.34) was significantly lower than that of the control group (18.53 ± 4.02, p < 0.001), the 12‐PSS score of the study group (11.20 ± 1.81) was significantly lower than that of the control group (16.47 ± 2.09, p < 0.001). KDTA of the study group (64.17 ± 8.07 vs. 47.83 ± 13.46, p < 0.001) and SF‐36 scores (65.37 ± 6.28 vs. 55.90 ± 14.28, p = 0.002) were significantly higher than that in the control group. The levels of hs‐CRP, P3+, iPTH, and β2‐MG in the study group after treatment were lower than those before treatment, and lower than those in the control group after treatment (all p < 0.05).ConclusionsThe Supra‐HFR can effectively reduce the itching symptoms of uremia patients and improve their quality of life.

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Association between uremic pruritus and long-term outcomes in patients undergoing dialysis

Cited by 9 publications

References 5 publications

Uremic pruritus and long-term morbidities in the dialysis population

Uremic pruritus and long-term morbidities in the dialysis population

Comparative efficacy of Chinese herbal medicines for dialysis patients with uremic pruritus: A systematic review and network meta-analysis

Early clinical observation of supra‐hemodiafiltration with endogenous reinfusion in the treatment of uremic pruritus

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