Dialysis Efficacy and Itching in Renal Failure

Masi, Christopher M.; Cohen, Eric P.

doi:10.1159/000187055

Cited by 41 publications

(32 citation statements)

References 9 publications

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“…It is based on the improvement of CKD-aP prevalence rates over time that have been presumed to be related to improvements in dialysis efficiency, 1 the association of pruritus with markers of under-dialysis, 30 and the controversial association of increased dialysis efficiency with a decrease in itching severity. 44,45 Implicated toxins have included vitamin A, aluminum, calcium, phosphorus, and magnesium. 1,19,46,47 …”

Section: Uremic Toxin Hypothesismentioning

confidence: 99%

Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges

Shirazian¹,

Aina²,

Park³

et al. 2017

IJNRD

107

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Chronic kidney disease-associated pruritus (CKD-aP) is a distressing, often overlooked condition in patients with CKD and end-stage renal disease. It affects ~40% of patients with end-stage renal disease and has been associated with poor quality of life, poor sleep, depression, and mortality. Prevalence estimates vary based on the instruments used to diagnose CKD-aP, and standardized diagnostic instruments are sorely needed. Treatment studies have often yielded conflicting results. This is likely related to studies that are limited by small sample size, flawed designs, and nonstandardized diagnostic instruments. Several large well-designed treatment trials have recently been completed and may soon influence CKD-aP management.

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Section: Uremic Toxin Hypothesismentioning

confidence: 99%

Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges

Shirazian¹,

Aina²,

Park³

et al. 2017

IJNRD

107

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“…Our data, in agreement with those of Balaskas et al [6], further support the observation that dialysis adequacy was not the single factor contributing to pruritus. The relationship between biochemical characteristics and PS is still questionable although many hypotheses have been advanced [1][2][3][4][5]. The lack of an association is supported by our failure to establish a relationship between clinical parameters and PS in our CAPD population (table 3).…”

Section: Discussionmentioning

confidence: 86%

“…Several factors have been suggested to be involved in the pathogenesis of pruritus [1][2][3], namely hypercalcemia, hyperphosphatemia, hypermagnesemia, and elevated plasma parathyroid hormone with high calcium phosphate product, albeit conflicting results remained [4,5]. To our knowledge, however, only few data concerning the pruritus in continuous ambulatory peritoneal dialysis (CAPD) patients are available [6,7].…”

Section: Introductionmentioning

confidence: 99%

Viral Hepatitis Infection Should Be Considered for Evaluating Uremic Pruritus in Continuous Ambulatory Peritoneal Dialysis Patients

Hung

Shyu²,

Tsai³

et al. 1998

Blood Purif

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Determining the possible association of viral hepatitis infection and degree of pruritus is the primary concern of this study. Ninety-six adequately dialyzed CAPD patients (47 male and 49 female) and 526 normal controls (266 male and 260 female) were enrolled. Blood hemoglobin, ferritin, electrolytes, calcium, phosphate, albumin, urea, creatinine, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase, and bilirubin were analyzed by routine methods. Serum HBsAg was examined, using a radioimmunoassay method and the anti-HCV, an enzyme immunoassay method. All cases were interviewed with a standardized questionnaire. The highest possible pruritus score (PS) was 22. The prevalences of HBsAg(+) and anti-HCV(+) were 14.6% and 17.7%, respectively. The mean PS in all 96 CAPD patients was 11.6 (range 7–22). The mean PS were 11.8 ± 0.6 and 12.5 ± 1.0 for patients infected with HBV and HCV, respectively. Both were significantly higher than that (10 ± 0.9) of patients without hepatitis infection. AST and ALT were significantly higher in patients infected with viral hepatitis than those without. The other biochemical parameters were not significant. Thirty-seven (38.5%) of our 96 patients had mild pruritus (PS 7) and 11 (15.9%) had severe pruritus (PS ≧15). Of the 83.9% (26/31) patients with viral hepatitis, the grades of skin itching were moderate to severe; whereas those of the patients without viral hepatitis, 53.6% (37/69) belonged to the group of moderate to severe pruritus (p = 0.003, χ² test with Yates’ correction). The authors recommended screening of viral hepatitis infection to be undertaken for uremic patients with unexplained skin itching.

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“…It has been suggested that perhaps the physiological changes associated with aging combined with the prolongation of life by dialysis may contribute to the increased incidence of pruritus [4]. However, pruritus is severe and a subsequent clinical problem only in a small proportion (about 10%) of pruritic patients, probably because optimal dialysis seems to improve uremic pruritus [2, 3]. In our study there was no difference in laboratory parameters between the groups with and without pruritus, and we cannot attribute presence and severity of pruritus to uremic and nutritional states, homeostasis of divalent ions, parathyroid hormone, and dose and quality of dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of uremic pruritus remains unknown, and no explanation of its pathophysiology is completely valid for all cases [1]. Recently, it has been reported that higher dialysis efficacy with good nutritional state reduces prevalence and degree of pruritus [2, 3] and that the symptoms are severe in a small proportion (6–14%) of patients [4, 5, 6]. …”

Section: Introductionmentioning

confidence: 99%

Histamine and Serotonin in Uremic Pruritus: Effect of Ondansetron in CAPD-Pruritic Patients

Balaskas¹,

Bamihas²,

Karamouzis³

et al. 1998

Nephron

105

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Pruritus is a common, unpleasant symptom of uremic patients. Serotonin and histamine have been reported as possible mediators of uremic pruritus, and ondansetron is a potent and selective inhibitor of 5-HT₃ receptors. The aims of our study were (1) to evaluate the effect of ondansetron on uremic pruritus in continuous ambulatory peritoneal dialysis (CAPD) patients and its safety and (2) to investigate the role of histamine and serotonin in uremic pruritus. To study the prevalence and pathogenesis of uremic pruritus, CAPD and hemodialysis (HD) patients were asked to complete a pruritus questionnaire. The replies were scored based on numerical scales, and the results were evaluated by the same investigator who did not know the patients. Pruritus was graded, according to the total points for each patient, as mild, moderate, or severe. Of 54 patients on HD, 29 (53.7%) had pruritus, and of 43 patients on CAPD, pruritus was present in 21 (48.8%). In HD patients, pruritus was mild in 14 (48.3%), moderate in 12 (41.4%), and severe in 3 (10.3%) patients; the distribution in CAPD patients was 9 (42.9%), 10 (47.6%), and 2 (9.5%), respectively. There was no correlation between the presence and severity of pruritus and age, sex, primary renal disease, duration of dialysis, dialysis solutions used, and hematological and biochemical parameters except for serum histamine and serotonin levels and their product. Plasma histamine levels in CAPD patients were 13.1 ± 1.1 ng/ml in pruritic and 11.0 ± 3.9 ng/ml in nonpruritic patients (p = 0.06), serum serotonin levels were 115.6 ± 43.3 ng/ml and 64 ± 42.3 ng/ml (p < 0.05), respectively, and the histamine × serotonin product was 1,461 ± 576 and 646 ± 545 (p < 0.01), respectively. Eleven CAPD patients (6 males, 5 females) with a mean age of 66 (range 33–83) years and an average time on CAPD of 18 (range 3–31) months with moderate to severe pruritus were treated with ondansetron (4 mg twice daily p.o.) for a mean period of 3 (range 1–5) months. All patients responded to the treatment. There was a significant reduction of the severity of pruritus from the start of treatment, and on the 3rd day the pruritic score (mean value) was 10 (range 5–19) points, while at time 0 (before treatment) it was 26 (range 19–37) points (p < 0.0001). Pruritus disappeared in 7 patients at the end of the 1st week and in all patients at the end of the 2nd week of treatment. This effect was maintained during the study. Plasma histamine levels decreased significantly during the treatment from 12.9 ± 1.2 to 6.7 ± 5.9 ng/ml (p < 0.05). Also, serum serotonin levels were reduced from 125.1 ± 47.8 to 59.3 ± 27.5 ng/ml (p < 0.05) at the end of the 1st month of treatment, and the histamine × serotonin product showed a more significant reduction: from 1,544 ± 656 to 454 ± 436 (p < 0.01). Three patients reported an improvement in their nausea and vomiting during the treatment. Weekly clinical and laboratory examinations showed no side effects, adverse reactions, or other complications. Our data indicate that o...

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Dialysis Efficacy and Itching in Renal Failure

Cited by 41 publications

References 9 publications

Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges

Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges

Viral Hepatitis Infection Should Be Considered for Evaluating Uremic Pruritus in Continuous Ambulatory Peritoneal Dialysis Patients

Histamine and Serotonin in Uremic Pruritus: Effect of Ondansetron in CAPD-Pruritic Patients

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