Uremic pruritus and associated factors in hemodialysis patients: A multi-center study

Özen, Nurten; Çınar, Fatma İlknur; Askin, Dilek; Mut, Dilek

doi:10.23876/j.krcp.2018.37.2.138

Cited by 57 publications

(73 citation statements)

References 30 publications

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“…The results are important and agree with another study conducted in Pakistan [22]. Our study indicates that age, hemodialysis years, and timing of dialysis session had no significant association with 5-D scores, which is in agreement with previous studies [20,23].…”

Section: Discussionsupporting

confidence: 93%

Uremic Pruritus: Prevalence and Impact on Quality of Life and Depressive Symptoms in Hemodialysis Patients

Satti¹,

Arshad²,

Javed³

et al. 2019

Cureus

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Background End-stage renal disease (ESRD) is a major public health problem with many associated symptoms. Uremic pruritus (UP) develops in 40% of patients on hemodialysis and has major effects on the patient's life. It is also an independent risk factor for increased mortality, and its psychiatric implications remain poorly characterized in our local setup, where it tends to be underdiagnosed and undertreated. Objectives and rationale The study aims to report the prevalence of uremic pruritus in our study population and associate it with various patient parameters, which may define a subset of patients at high risk for this pruritus. We also assess the effects of uremic pruritus on the patient's quality of life (by using the Dermatology Life Quality Index; DLQI) and depressive symptoms (by using the Public Health Questionnaire; PHQ-9). Materials and methods It was a descriptive, cross-sectional study conducted in the nephrology unit of the multi-organ failure (MOF) center of the Holy Family Hospital (HFH), Rawalpindi, Pakistan, from February 2019 to June 2019, during which 173 male patients on hemodialysis were selected. Informed consent was taken from patients and other skin-related causes of pruritis were excluded. Uremic pruritus was defined as pruritis lasting for at least three months after the onset of ESRD. The 5-D, PHQ-9, and DLQI questionnaires were used to assess pruritis, depressive symptoms, and quality of life, respectively. Their Cronbach's Alpha values for 73 responses were 0.83, 0.81, and 0.71, respectively. The descriptive analysis was performed using SPSS v23.0 (IBM Corp, Armonk, NY, US). Spearman's rank-order correlation, independent samples t-test, and one-way analysis of variance (ANOVA) were used to analyze study variables. Results The prevalence of uremic pruritus was 49.1%, with many patients having generalized itching. Unemployment and longer disease duration predisposed the patients towards uremic pruritus, as the mean 5-D score in this subset were greater (p<0.05 in the independent samples t-test). The results of one-way ANOVA were significant (p<0.05), indicating higher 5-D scores in worsening categories of depressive symptoms and quality of life. Spearman's correlation matrix Open Access Original Article

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Section: Discussionsupporting

confidence: 93%

Uremic Pruritus: Prevalence and Impact on Quality of Life and Depressive Symptoms in Hemodialysis Patients

Satti¹,

Arshad²,

Javed³

et al. 2019

Cureus

View full text Add to dashboard Cite

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“…Yet another study in Pakistan reported almost similar patterns of pruritus severity with 50%, 28%, and 14% of respondents having mild, moderate, and severe pruritus, respectively [35]. Other cross-sectional studies in Turkey also showed a high prevalence of 85.4% [36], and 53.4% [37], respectively. However, 50.4% of patients experienced moderate pruritus, and pruritus led to sleep disturbances in 33.8% of patients [37].…”

Section: Discussionmentioning

confidence: 86%

“…Other cross-sectional studies in Turkey also showed a high prevalence of 85.4% [36], and 53.4% [37], respectively. However, 50.4% of patients experienced moderate pruritus, and pruritus led to sleep disturbances in 33.8% of patients [37]. In our study, a longer duration of CKD and hemodialysis had a very negligible effect on pruritus, which differs from another study in which a duration of hemodialysis of more than 2 years resulted in higher rates of pruritus (75% vs 25%) compared to those doing hemodialysis for less than 2 years [38].…”

Section: Discussionmentioning

confidence: 94%

Prevalence of chronic kidney disease-associated pruritus, and association with sleep quality among hemodialysis patients in Pakistan

et al. 2018

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BackgroundThe prevalence of chronic kidney disease-associated pruritus (CKD-aP) varies from 22% to 84% among patients receiving hemodialysis. It occurs more frequently at night, and often affects patient’s sleep quality. CKD-aP is often unreported by patients, and many do not receive effective treatment. There is, however, a paucity of available data on the prevalence and impact of CKD-aP on patients receiving hemodialysis in Pakistan.MethodsA multicenter cross-sectional study was undertaken from July 2016 to April 2017 at a tertiary care hospitals in Pakistan.Results354 patients undergoing hemodialysis were studied. 35.6% had CKD for 1–2 years, and 42.4% were receiving hemodialysis for 1–2 years. The prevalence of pruritus was 74%. The median [interquartile range] score for pruritus was 10.0 (out of possible 25) [8.0–12.0]; while the median [interquartile range] Pittsburgh Sleep Quality Index (PSQI) score was 8.0 (out of possible 21) [7.0–10.0]'. Pruritus was significantly correlated with the sleep score (r = 0.423, p<0.001). The results of the multivariate linear regression revealed a positive association between pruritus and age of patients (β = 0.031; 95% CI = 0.002–0.061; p = 0.038) and duration of CKD (β = -0.013; 95% CI = -0.023 –-0.003; p = 0.014). Similarly there was a positive association between sleep score and duration of CKD (β = 0.010; 95% CI = 0.002–0.019; p = 0.012) and pruritus (β = 0.143; 95% CI = 0.056–0.230; p = 0.001).ConclusionsChronic kidney disease-associated pruritus is very common in patients receiving hemodialysis in Pakistan. Pruritus is significantly associated with poor sleep quality.

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“…www.nature.com/scientificreports www.nature.com/scientificreports/ A previous large study showed that approximately 42% of patients with HD experience moderate to extreme pruritus 29 . Severe uremic pruritus may cause deteriorating QOL and poor clinical outcomes in chronic HD patients 30,31 . Reasons for the occurrence of pruritus remain unknown, but the possibility of an association of uremic pruritus with middle molecules such as β2-microglobulin has been reported; therefore, the increased clearance of middle molecules may help reduce uremic pruritus 32,33 .…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of medium cut-off versus high-flux dialyzers on quality of life outcomes in maintenance hemodialysis patients

Lim

Park

Yook

et al. 2020

Sci Rep

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Medium cutoff (MCO) dialyzers help remove larger middle molecules associated with symptoms related to the accumulation of uremic retention solutes. We investigated the effect of an MCO dialyzer on the improvement of quality of life (QOL) in maintenance hemodialysis (HD) patients. Forty-nine HD patients with high-flux dialysis were randomly assigned to either an MCO (Theranova 400, Baxter) or a high-flux (FX CorDiax 80 or 60, Fresenius Medical Care) dialyzer and completed the study. QOL was assessed at baseline and after 12 weeks of treatment using the Kidney Disease Quality of Life Short Form-36, and pruritus was assessed using a questionnaire and visual analog scale. The reduction ratios of middle molecules were also evaluated. Laboratory markers, including serum albumin, did not differ between the two groups after 12 weeks. Removals of kappa and lambda free light chains were greater for MCO dialyzer than high-flux dialyzer. The MCO group had higher scores than the high-flux group in the domains of physical functioning and physical role (75.2 ± 20.8 vs. 59.8 ± 30.1, P = 0.042; 61.5 ± 37.6 vs. 39.0 ± 39.6, P = 0.047, respectively), and the MCO group had lower mean scores for morning pruritus distribution and the frequency of scratching during sleep (1.29 ± 0.46 vs. 1.64 ± 0.64, P = 0.034; 0.25 ± 0.53 vs. 1.00 ± 1.47, P = 0.023, respectively). MCO dialyzers may improve patientreported outcomes, particularly the physical components of QOL and uremic pruritus, in patients with high-flux dialyzers. Patients on maintenance dialysis suffer variable symptoms such as fatigue, generalized weakness, and pruritus. These subjective conditions are assumed to be related to middle molecules that are not cleared by conventional hemodialysis (HD) 1. Middle molecules have molecular weights (MWs) ranging between 500 and 60,000 daltons, and their size is a barrier to removal with dialyzers 2,3. The accumulation of middle molecules is associated with specific complications such as amyloidosis, inflammatory reactions, oxidative stress, and endothelial dysfunction 3-5. Consequently, middle molecules contribute to morbidity and mortality and poor quality of life (QOL) in end-stage renal disease (ESRD) patients 6,7. High-flux dialysis, which has benefits for middle molecule clearance, has not displayed a clear mortality advantage compared with low-flux dialysis; the survival benefits of high-flux dialysis were only observed in patients with hypoalbuminemia and diabetes 8,9. Another dialytic modality, hemodiafiltration (HDF) with increased convection, has a higher efficiency for reducing middle-sized solutes than high-flux dialysis 10,11. Large randomized trials comparing HDF and high-flux dialysis have shown conflicting patient outcome results 12-15 ; however, recent results have consistently shown that HDF with a high convection volume improves patient survival 16-18. Medium cutoff (MCO) dialyzers are characterized by a more even distribution of larger pore sizes and a higher number of pores. MCO dialyzers have a higher permeability and...

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Uremic pruritus and associated factors in hemodialysis patients: A multi-center study

Cited by 57 publications

References 30 publications

Uremic Pruritus: Prevalence and Impact on Quality of Life and Depressive Symptoms in Hemodialysis Patients

Uremic Pruritus: Prevalence and Impact on Quality of Life and Depressive Symptoms in Hemodialysis Patients

Prevalence of chronic kidney disease-associated pruritus, and association with sleep quality among hemodialysis patients in Pakistan

Randomized controlled trial of medium cut-off versus high-flux dialyzers on quality of life outcomes in maintenance hemodialysis patients

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