Association of uraemic pruritus with inflammation and hepatitis infection in haemodialysis patients

Chiu, Yen‐Ling; Chen, Hung Yuan; Chuang, Yi Fang; Hsu, Shih Ping; Lai, Chun-Fu; Pai, Mei Fen; Yang, Shan-Yi; Yu, Peng

doi:10.1093/ndt/gfn303

Cited by 50 publications

(50 citation statements)

References 33 publications

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“…With regards to UP characteristics, our results found that severe pruritus was observed in the studied population, as represented by a median VAS of 7 (5-8), according to the adopted classification in previous studies [9,17,20]. It is important to note that some studies have found an increased mortality risk in patients undergoing dialysis associated with severe pruritus, e.g., when the pruritus VAS score was greater than 7 [17,21].…”

Section: Discussionsupporting

confidence: 53%

“…It is important to note that some studies have found an increased mortality risk in patients undergoing dialysis associated with severe pruritus, e.g., when the pruritus VAS score was greater than 7 [17,21]. The DOPPS study found that patients presenting with UP had a 17% greater mortality risk [3].…”

Section: Discussionmentioning

confidence: 99%

“…Inflammation is associated with UP, and patients presenting severe pruritus could therefore have high CRP levels [16], which justify our findings. Narita et al noted that the development of severe pruritus (VAS>7) was related to multiple factors, such as higher levels of creatinine, urea, β2-microglobuline, PTH, calcium, phosphate and CRP, and they indicated that patients with higher levels of CRP had a lower survival rate [17].…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with uremic pruritus

et al. 2017

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Background: The etiopathogenesis of uremic pruritus (UP) is multifactorial aspect, and it is thus necessary to elucidate its associated factors to develop efficient therapeutics approaches. This study aimed to verify the prevalence of UP and its associated factors. Methods and Findings:Prospective and cross-sectional study with patients undergoing hemodialysis at a university public hospital. The data were obtained between April 2014 and April 2015. The statistical analysis was carried out using multivariate regression models, and statistical significance was set at p<0.05. A total of 164 patients were included, and pruritus was reported in 64 (39%). In the multivariate analysis, a higher creatinine level was risk factor for pruritus (β=1.09, 95% CI 1.00-1.19; p=0.048), as was a lower level of hemoglobin (β=0.85, 95% CI 0.73-0.99; p=0.043). Dyslipidemia (β=1.52, 95% CI 0.12-2.91; p=0.03), obesity (β=2.40, 95% CI 1.03-3.78; p=0.001), higher levels of C-reactive protein (β=0.26, 95% CI 0.19-0.34; p<0.001) and black race (β=1.49, 95% CI -2.57 and 0.42; p<0.006) were associated with a greater intensity of pruritus. The use of a high-flux dialyzer was associated with a lower intensity of pruritus (β=-1.69, 95% CI -3.05-0.34; p=0.01). Conclusion:Uremic pruritus has a high prevalence in hemodialysis patients, and the data suggest that the higher the creatinine and the lower the hemoglobin levels are, the greater the risk of developing pruritus is. Dyslipidemia, obesity, and higher levels of C-reactive protein were associated with a greater intensity of pruritus, whereas the use of a high-flux dialyzer was associated with lower pruritus intensity.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Factors associated with uremic pruritus

et al. 2017

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“…Secondary hyperparathyroidism [3,5] and viral hepatitis [19] have been reported to cause pruritus in hemodialysis patients. Thus, we believe clinicians should take particular note of pruritus in hemodialysis patients with secondary hyperparathyroidism or viral hepatitis.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the Japanese version of the 5-D itch scale for rating pruritus experienced by patients undergoing hemodialysis

et al. 2018

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Background: Pruritus in patients undergoing hemodialysis reduces quality of life via insomnia and depression, and negatively affects prognosis. For diagnosing pruritus, selecting therapeutic strategies, and determining therapeutic outcomes, methods are needed for objectively quantifying the degree of itchiness. In 2015, the Japanese version of the 5-D itch scale (5D-J), originally developed in the USA in 2010, was developed as a simple self-administered questionnaire; it evaluated the degree of itchiness based on five components: (1) duration of itchiness, (2) degree of itchiness, (3) direction of itchiness, (4) disability caused by itchiness, and (5) distribution of itchiness. 5D-J is useful for comprehensively assessing multiple elements related to itchiness. We used 5D-J to assess the degree of itchiness experienced by patients undergoing hemodialysis to investigate its clinical usefulness. Methods: Subjects were 336 patients undergoing maintenance hemodialysis at our facility in October 2016; they were selected from 383 patients, of whom 20 were excluded because their itchiness had a dermatologic origin and 27 were excluded because their localized itchiness was related to vascular access, respectively. The status of itchiness (duration, degree, direction, disability, and distribution) of the patients was surveyed in October 2016 using 5D-J; total scores were calculated and used for assessing the itchiness experienced by patients. We additionally investigated whether 5D-J scores correlated with visual analog scale (VAS) and Shiratori severity scores for pruritus. Results: Degree was reported as "not present" by 124 patients (36.9%), "mild" by 164 (48.8%), "moderate" by 46 (13.7%), "severe" by 2 (0.6%), and "unbearable" by 0 (0%). Total score was 5 points in 55 patients (16.4%), 6-9 in 176 (52.4%), 10-14 in 95 (28.3%), 15-19 in 9 (2.7%), 20-24 in 1 (0.3%), and 25 in 0 (0%). The 5D-J total and VAS scores were strongly correlated (r = 0.7159; p < 0.001). The 5D-J total score correlated with "daytime itchiness" (r = 0.6441; p < 0.001) and "nighttime itchiness" (r = 0.6352; p < 0.001) on the Shiratori severity score. Conclusions: 5D-J may be useful for objectively assessing itchiness experienced by patients undergoing hemodialysis.

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“…Kimmel et al realized that, among the same patients, the ratio of Th1 (measured using CXCR3 as a chemokine receptor and IFN-γ) to Th2 (measured by CCR4 as a chemokine receptor and IL-4) were also higher. In addition, a higher serum level of ferritin and CRP as an acute phase protein and a lower serum level of transferrin and albumin as negative acute phase protein in HD patients with UP compared with the same patients without UP supported the probable role of inflammation in UP (33,34). Additional evidence regarding this immunohypothesis is the decrease in UP following ultraviolet B (UVB) irradiation to even half of the body (35).…”

Section: Discussionmentioning

confidence: 96%

Effects of Fumaria parviflora L on Uremic Pruritus in Hemodialysis Patients: A Randomized, Double-Blind, Placebo-Controlled Trial

Akrami

Hashempur

Tavakoli

et al. 2016

Jundishapur J Nat Pharm Prod

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Background: Uremic pruritus (UP) is a common, bothersome symptom in hemodialysis (HD) patients with end-stage renal disease. Immunohypothesis is currently favored as an explanation of the cause of UP. Fumaria parviflora L (FP) is a medicinal herb with several pharmacological properties, including prominent anti-inflammatory activity. Objectives: This study aimed to assess the efficacy of FP for reducing UP severity among HD patients. Methods: A total of 79 HD patients with pruritus were randomly assigned to receive either FP or a placebo for eight weeks. The visual analogue scale (VAS), the Duo score for calculating pruritus score, serum interferon-γ (IFN-γ) level, interleukin-4 (IL-4), and high-sensitivity C-reactive protein were measured in the patients before and after treatment. Results: At the end of the treatment phase, the pruritus score decreased in both groups (P < 0.001); however, the mean reduction

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Association of uraemic pruritus with inflammation and hepatitis infection in haemodialysis patients

Abstract: Our study demonstrated the heavy burden of pruritus in HD patients and corroborated the role of inflammation in the pathogenesis of uraemic pruritus. HCV infection is associated with severe uraemic pruritus but is independent of the serum hsCRP level in HD patients.

Cited by 50 publications

References 33 publications

Factors associated with uremic pruritus

Factors associated with uremic pruritus

Usefulness of the Japanese version of the 5-D itch scale for rating pruritus experienced by patients undergoing hemodialysis

Effects of Fumaria parviflora L on Uremic Pruritus in Hemodialysis Patients: A Randomized, Double-Blind, Placebo-Controlled Trial

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