Clinical features and risk factors of pruritus in patients with chronic renal failure

Abstract

Dermatological manifestations are common in systemic diseases, such as chronic kidney disease. The present study investigated the clinical features and possible influencing factors of pruritus in patients with chronic renal failure (CRF). A total of 382 inpatients were enrolled from the Department of Nephrology at The Second Affiliated Hospital of Chongqing Medical University. A total of 138 subjects were hemodialysis patients, 41 were peritoneal dialysis patients, and 203 were chronic renal failure patients. The patients' clinical performance was observed, and the data was recorded for analysis. The prevalence of pruritus in hemodialysis patients was greater than that in peritoneal dialysis patients. A total of 187 patients were accompanied by xerodermia and 109 patients had pruritus at the same time. With effective and regular dialysis, pruritus could be alleviated in 40% of patients. The intensity of pruritus in the enrolled patients ranged from mild itching to irritability during day and night periods. Moreover, pruritus was intermittent or persistent, and/or limited to generalized. Following treatment, 35% of patients had poor results. A significant difference was noted in the levels of serum urea nitrogen, creatinine, serum phosphorus, calcium × phosphorus, and parathyroid hormone (PTH) between patients with pruritus and non-pruritus. Xerodermia is a common skin manifestation in patients with chronic renal failure and is associated with the occurrence of pruritus. Local cold and heat stimulation can relieve pruritus to some extent, and adequate hemodialysis can also relieve itching.

Therapeutic effect of intravenous sodium thiosulfate for uremic pruritus in hemodialysis patients

“…STS induces calcium removal through chelation, and the dysregulation of calcium and phosphorous metabolism and hyperparathyroidism are clearly risk factors for uremic pruritus [2,44]. However, our observations showed that the calcium and phosphate values did not change significantly after therapy.…”

“…Uremic pruritus may be due to an allergy to the tubing, dialyzer, or other elements associated with dialysis [ 2 , 28 ]. The literature has shown associations between demographic and clinical characteristics of patients and the severity of pruritus, such as aluminum level [ 29 ], secondary hyperparathyroidism, elevated blood urea nitrogen level [ 30 ], hypercalcemia and hyperphosphatemia [ 31 ], the duration of dialysis [ 32 ], low Kt/V and sex.…”

“…Uremia affects almost all body organs, including the skin, through different mechanisms, such as biochemical, vascular, neurologic, immunologic, hematologic, electrolyte-related, and volume imbalance-mediated mechanisms [1]. Pruritus is one of the common symptoms in uremic patients undergoing hemodialysis (HD) [2]. Patients with more severe pruritus tended to have higher serum C-reactive protein (CRP) levels and lower serum albumin levels [3].…”

Have We Just Scratched the Surface? A Narrative Review of Uremic Pruritus in 2020

“…8,[109][110][111][112][113][114] Six of these studies were limited by few patients on dialysis, unadjusted analyses, and/or imbalanced male-to-female ratio. 8,[110][111][112][113][114] Effect of sex on the pathogenesis of disease. Interest in the inclusion of sex as a consideration in uremic pruritus disease is bolstered by well-established relationships between sex and itch-related mechanisms.…”

[Editorial] Immuno-dermatological processes involved in chronic skin diseases: Highlights of the Second Conference of the Romanian Society for Immuno-Dermatology, Bucharest, September, 2018

“…Hu et al (15) aimed their study in investigating the clinical features and possible influencing factors of pruritus in patients with chronic renal failure proving a significant difference in the levels of serum urea nitrogen, creatinine, serum phosphorus, calcium × phosphorus, and PTH (parathyroid hormone) between patients with pruritus and non-pruritus. They also showed that local cold and heat stimulation can relieve pruritus to some extent, and adequate hemodialysis can also relieve itching as well as reducing xeroderma.…”