Clinicoepidemiological study of skin manifestations in patients of chronic renal failure on hemodialysis

Abstract

Background:Chronic renal failure (CRF) is associated with a variety of cutaneous manifestations as a result of underlying etiology as well as the various treatment modalities.Aim:To evaluate the prevalence of various dermatoses in patients with CRF on hemodialysis and to study the effect of hemodialysis on the intensity of pruritus.Materials and Methods:A total of 35 patients of CRF on hemodialysis having at least one cutaneous manifestation were included in the study.Results:Twenty-four (68.71%) cases in our study belonged to the age group of 50-69 years, out of which 16 cases were in the sixth decade. Xerosis and pruritus occurred in 80% and 65.71% of cases, respectively. Other common findings included pallor (68.57%), dyspigmentation (34.29%), cutaneous infections (34.39%), acquired perforating dermatosis (17.4%), and nail changes (60%). Hemodialysis failed to improve pruritus in 17 (73.9%) of our patients. Twenty-six patients (74.28%) suffered from hypertension, 13 of them also were known cases of type II diabetes mellitus. Five patients suffered exclusively from type II diabetes mellitus.Conclusions:In our small study, xerosis was the commonest finding and pruritus, the commonest symptom. The intensity of pruritus was largely unaffected by hemodialysis.

A clinico-epidemiological study of cutaneous changes in chronic kidney disease

“…1,7 In a study by Deshmukh et al 91.42% of patients had co-morbidities including hypertension in 37.15% of patients, diabetes in 14.28% of patients and both diabetes and hypertension in 37.15% of patients. 2 In our study 74% of patients had co-morbidities that included hypertension in 44% of patients, diabetes in 7% of patients and both diabetes and hypertension in 8% of patients. The lower prevalence of co-morbidities in our study may be attributed to the rural and semi-urban background of the patients.…”

“…10 The prevalence of xerosis has ranged from 52.8 to 80% in various studies. 2,4,8,9 In the present study 25 patients (50%) had infections and infestations. Out of these patients 15 had fungal infections, 7 had furunculosis, 2 had carbuncles and 1 had scabies.…”

“…[2][3][4] Most of these have been urban population based studies. We have carried out a rural and semi-urban population based prevalence study on cutaneous changes in CKD in patients mainly from the Saharanpur district of Uttar Pradesh in North India.…”

“…Anaemia is attributable mainly to reduced erythropoietin production in CKD. 2 The prevalence of pallor has ranged from 45.45 to 68.57% in various studies.…”

“…The prevalence of nephrogenic pruritus has ranged from 26.7 to 65.17% in various studies. 2,4,8,9 The factors implicated in the pathogenesis of nephrogenic pruritus include integumentary changes related to xerosis, chemical neurotransmitters including enkephalins, pentapeptide and serotonin, microinflammation with elevated Th 1 lymphocytes, diavalent ions such as calcium and phosphorus, parathyroid hormone, opioid peptides and mast cell proliferation with elevated histamine. 4,[10][11][12][13] Nephrogenic pruritus is refractory to treatment but may respond to emollients, topical calcineurin inhibitors, UVB phototherapy, gabapentin, the opioid antagonist naltrexone and parathyroidectomy.…”