Optimal dialysis improves uremic pruritus

Hiroshige, Kinya; Kabashima, Narutoshi; Takasugi, Masayuki; Kuroiwa, Akio

doi:10.1016/0272-6386(95)90102-7

Cited by 125 publications

(93 citation statements)

References 16 publications

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“…In a study from 1995, increasing Kt/V from a mean of 1.05 to 1.24 led to an improvement in pruritus (25). However, no association between Kt/V and pruritus was found in this study, where the mean Kt/V was 1.5, consistent with other recent studies (2,24).…”

Section: Discussionsupporting

confidence: 86%

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

Rayner¹,

Larkina²,

Mia³

et al. 2017

CJASN

174

238

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Background and objectives Uremic pruritus in patients on hemodialysis is associated with depression, lower quality of life, and mortality. We studied the prevalence, awareness, and treatment of pruritus to assess how well this important condition is currently managed internationally.Design, setting, participants, & measurements Data from 35,452 patients on hemodialysis in up to 17 countries from the Dialysis Outcomes and Practice Patterns Study were analyzed to describe pruritus prevalence from 1996 to 2015. Data from 6256 patients and 268 medical directors in 17 countries in 2012-2015 were analyzed to describe predictors, effects, medical directors' awareness, and treatment of pruritus.Results Patients very much or extremely bothered by itching declined from 28% in 1996 to 18% in 2015. In 2012-2015, among patients nearly always or always bothered by itching, pruritus had a major effect on work and social life; 18% used no treatment for pruritus, and 17% did not report itching to health care staff. In total, 69% of medical directors underestimated the prevalence of pruritus in their unit. Managing high serum phosphorus and low Kt/V was ranked as the most important intervention, but no relationship was found between these factors and pruritus; 57% of medical directors used oral antihistamines for first-line chronic treatment of pruritus. Gabapentin was used by 45% as first-, second-, or third-line treatment. Nalfurafine was only used in Japan.Conclusions The prevalence of pruritus in people on hemodialysis is decreasing but remains underestimated. Large numbers of patients on hemodialysis with severe pruritus do not receive treatment. There is wide variation in the use of unlicensed medications for the treatment of pruritus. These data provide a benchmark for initiatives to improve the management of uremic pruritus.

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Section: Discussionsupporting

confidence: 86%

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

Rayner¹,

Larkina²,

Mia³

et al. 2017

CJASN

174

238

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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%

“…The only randomized trial to examine the effect of increased dialysis intensity on CKD-aP was by Hiroshige et al 44 In this trial, 22 HD patients with severe prolonged pruritus were randomly assigned either to increased dialysis or unchanged dialysis. After 3 months, there was a significantly higher percentage of patients with improved pruritus in the group …”

Section: Uremic Toxin Removalmentioning

confidence: 99%

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

Shirazian¹,

Aina²,

Park³

et al. 2017

IJNRD

102

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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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“…However, it still remains uncertain whether alterations in dialysis therapy including changes in dialysis membrane can reduce pruritus [24] [25] or not [26]. Hiroshige et al [27] analyzed data on 59 HD patients, who did not have disorders in calcium and phosphate metabolism, and found that more than 60% of them suffered from disabling pruritus possibly related to chronic uremia. Blood urea nitrogen (BUN) and plasma β 2 -microglobulin, both of which are biochemical factors that are associated with the prevalence of pruritus and dialysis efficacy, were investigated and calculated by urea kinetics.…”

Section: Modification Of Dialysis Techniquesmentioning

confidence: 99%

Recent Advances in Treatment for Uremic Pruritus

Suzuki¹,

Omata²,

Kumagai³

2015

OJNeph

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This review highlights recent advances in pathophysiology and treatment for uremic pruritus, especially focusing on various interventions. Pruritus in patients on hemodialysis (HD) and peritoneal dialysis (PD) still remains an unresolved issue. Recently, the efficacy and safety of nalfurafine hydrochloride have been reported in Japan, and at present, more than thirty thousand patients receive this new drug. In comparison with the efficacy of this new drug, acupuncture, a form of traditional Japanese therapy, has been validated for relief of symptoms of pruritus. In this review, various interventions for relief of symptoms of pruritus as well as recent studies on its pathophysiology will be introduced. This review will be helpful for treatment of pruritus in patients on dialyzed therapy in clinical practice.

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Optimal dialysis improves uremic pruritus

Cited by 125 publications

References 16 publications

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

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

Recent Advances in Treatment for Uremic Pruritus

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