Short-Term Efficacy of Tacrolimus Ointment in Severe Uremic Pruritus

Pauli‐Magnus, Christiane; Klumpp, Siegfried; Alscher, Mark Dominik; Kuhlmann, Ulrich; Mettang, Thomas

doi:10.1177/089686080002000641

Cited by 74 publications

(31 citation statements)

References 4 publications

(2 reference statements)

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“…[12][13][14][15] Moreover, immunosuppressive medications like thalidomide and tacrolimus reduced pruritus to a substantial extent. 2,16,17 It is noteworthy that patients with a kidney transplant, independent of the degree of kidney failure experienced, almost never complain of pruritus as long as the immunosuppressive therapy is continued. 2,18 Furthermore, the immunosuppressive therapy frequently used in patients with glomerulopathies may explain why our patients with glomerulopathies had a statistically lower prevalence of pruritus than patients with other causes of ESRD.…”

Section: Discussionmentioning

confidence: 99%

Pruritus in hemodialysis patients: The problem remains

Melo

Elias

Castro

et al. 2009

Hemodialysis International

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Pruritus is still one of the most common and disturbing symptoms of end-stage renal disease. The objective of this study is to analyze the prevalence of pruritus in hemodialysis patients and the possible factors implicated in its genesis. In a cross-sectional study, 101 patients on hemodialysis at our center were screened for pruritus. The relationship of various factors with pruritus was evaluated. Of the 101 patients included, 31(30.7%) had pruritus at the time of examination. Patients with pruritus were significantly older than those without pruritus (P=0.0027). Pruritus tended to be more prevalent in patients undergoing dialysis 3 times a week than in those undergoing daily dialysis, but the difference did not reach statistical significance (P=0.0854). Lower transferrin saturation levels were found in patients with pruritus than in those without pruritus (P=0.0144). C-reactive protein levels were significantly higher in patients with pruritus than in those without pruritus (P=0.0013). There was no significant difference between the groups in the levels of the other inflammatory biomarkers measured. However, there was a tendency toward a correlation between the levels of alpha-1-glycoprotein and the intensity of pruritus (P=0.0834). Our results suggest a possible relationship of the inflammatory response upregulation to pruritus. Additionally, there was a positive relationship between pruritus and iron deficiency, possibly associated with inflammatory elevation of hepcidin. A better understanding of the factors implicated in the genesis of pruritus related to end-stage renal disease is crucial in the development of more effective treatments for this symptom.

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Section: Discussionmentioning

confidence: 99%

Pruritus in hemodialysis patients: The problem remains

Melo

Elias

Castro

et al. 2009

Hemodialysis International

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“…74 Kimmel et al found that HD patients with pruritus had significantly enhanced Th1 cytokines and IL-6 levels. 68 In line with this theory, ultraviolet B (UVB) light, 75 tacrolimus, 76,77 and thalidomide 78 alleviate pruritus in patients with ESRD. UVB attenuates Th1 cell differentiation and decreases IL-2 production.…”

Section: Pathophysiology Of Itch In Esrdmentioning

confidence: 96%

New insights into the pathophysiology and treatment of chronic itch in patients with end‐stage renal disease, chronic liver disease, and lymphoma

Wang¹,

Yosipovitch

2009

Int J Dermatology

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IntroductionChronic itch associated with systemic diseases continues to be one of the most bothersome dermatological symptoms accompanying end-stage renal disease (ESRD), chronic liver diseases, and lymphoma. The International Forum for the Study of Itch has recently issued a consensus paper on different types of chronic pruritus, including pruritus in systemic diseases that can present with or without secondary skin changes.1Various types of itch have been described based on the origin of the itch, which could be skin-related, neuropathic, systemic, or psychogenic.2 At any given time patients with these systemic diseases may have more than one origin, for example, patients with end-stage renal disease (ESRD) could have neuropathic itch due to nerve fibers damage, as well as itch associated with skin inflammation such as perforating folliculitis. Itch adversely affects quality of life of patients, leading to sleep deprivation and depression that further augment itch. Chronic itch associated with systemic diseases range from mild to intractable, which is defined as a chronic itch state in which the cause cannot be removed or treated, and no relief or cure has been found in the generally accepted course of medical practice.3 In the last decade, there are significant advances in our understanding of specific itch neuronal pathways, mediators and relevant receptors, opening the field for development of new antipruritic strategies. The purpose of this review is to highlight the new findings related to the pathophysiological mechanisms and the treatment of itch associated with the most common systemic diseases including ESRD, chronic liver disease and lymphoma. EpidemiologyA recent study estimated that approximately one in five dermatology outpatients with generalized pruritus with no obvious dermatologic cause may have an underlying systemic cause.4 This result underscores the significance of ruling out potential underlying systemic diseases when seeing a patient with generalized itch.Chronic itch remains as one of the most common symptoms in patients with ESRD, particularly in hemodialysis (HD) patients. Although the prevalence of itch has decreased in the last 30 years, itch remains a major problem in ESRD. The overall prevalence of pruritus in a recent study in US was 57%.5 The largest study so far analyzed data from 18,801 HD (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004) and indicated that 42% of HD patients experienced moderate to extreme pruritus.6 Several smaller studies found that significant itch affects 15%-49% of patients with chronic renal failure and 50%-90% of the dialysis population.7 Most of these studies showed ESRDassociated itch being independent of gender, age, ethnicity and types of dialysis. The prevalence of chronic kidney disease has increased in the last decades and is predicted to continue to rise worldwide,8 suggesting that chronic itch associated with ESRD will remain as a major health problem in this population.Pruritus is common in chronic cholestatic liver disease. It is more ...

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“…There are no head-to-head comparisons between these agents. Topical Tacrolimus was reported to decrease uremic pruritus in a case series, but this was refuted in a larger study (47,48). While the therapeutic window of topical agents is large, it should be noted that systemic absorption of some of these agents can occur, and thus they cannot be used without regard for the potential of systemic toxicity.…”

Section: Topical Agentsmentioning

confidence: 99%

Pharmacologic Treatment of Common Symptoms in Dialysis Patients: A Narrative Review

Moledina

Wilson

2015

Seminars in Dialysis

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End-stage renal disease (ESRD) patients receiving hemodialysis experience a heavy burden of disease-related symptoms, which lead to reduced quality of life. This review focuses on aspects of ESRD-related pharmacokinetics and on efficacy of drugs for treatment of somatic symptoms. Fatigue, pruritus, insomnia, and cramps are the most common symptoms in ESRD, and studies suggest that they are often undertreated. However, few evidence-based guidelines exist to guide therapy in patients received dialysis. In the context of this review, we examine the role of l-Carnitine in the treatment of fatigue and cramps; human growth hormone analog Norditropin and anabolic steroid Nandrolone for the treatment of fatigue; Gabapentin and other agents for the management of pruritis; Vitamin and creatine supplementation in the management of dialysis-associated cramps, and somnambulates in the treatment of dialysis-related insomnia. Treatment decisions should be made in consultation with patients with a full accounting of the potential risks and benefits of these therapies.

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Short-Term Efficacy of Tacrolimus Ointment in Severe Uremic Pruritus

Cited by 74 publications

References 4 publications

Pruritus in hemodialysis patients: The problem remains

Pruritus in hemodialysis patients: The problem remains

New insights into the pathophysiology and treatment of chronic itch in patients with end‐stage renal disease, chronic liver disease, and lymphoma

Pharmacologic Treatment of Common Symptoms in Dialysis Patients: A Narrative Review

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