Uremic pruritus is associated with higher Kt/V and serum calcium concentration

Mi, Duque; Thevarajah, Suganthi; Chan, Yau-Chi; Ab, Tuttle; Bi, Fangfang; Yosipovitch, Gil

doi:10.5414/cnp66184

Cited by 94 publications

(90 citation statements)

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“…Spatial distribution of pruritus indicated the involvement of large, nondermatomal areas with striking mirror symmetry. Expanding on the work of prior studies (16,20,21), we have reported for the first time that distribution of pruritus can change markedly over time in individuals, and yet bilateral symmetry is maintained. These findings point to a prominent central neurogenic component to UP which deserves further exploration.…”

Section: Discussionmentioning

confidence: 99%

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A Longitudinal Study of Uremic Pruritus in Hemodialysis Patients

Mathur

Lindberg²,

Germain³

et al. 2010

Clinical Journal of the American Society of Nephrology

240

304

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Background and objectives: Although uremic pruritus (UP) is a highly prevalent complication of chronic kidney disease, it remains poorly characterized. There have been no longitudinal studies of natural history, and no health-related quality of life (HR-QOL) instruments have been developed for UP. The objectives of this study were to describe the natural history of UP, to compare rating scales of itching intensity, and to assess usefulness and validity of HR-QOL instruments for UP.Design, setting, participants, & measurements: The intensity, severity, and effects of pathologic itching on HR-QOL were assessed prospectively in 103 patients with UP on chronic hemodialysis. Outcome measures were obtained at scheduled intervals over 3.5 months.Results: Itching daily or nearly daily was reported by 84% of patients and had been ongoing for >1 year in 59%. In 83%, pruritus involved large, nondermatomal areas with striking bilateral symmetry. Two thirds of the patients were using medications such as antihistamines, steroids, and various emollients without satisfactory relief of itching. Statistically significant associations were found among itching intensity, severity, and HR-QOL measures in domains such as mood, social relations, and sleep. Among patients with moderate-to-severe UP, changes in itching intensity of 20% or greater were associated with significant reductions in HR-QOL measures.Conclusions: This first longitudinal study of UP describes key features of UP and its effect on HR-QOL. The assessment instruments we have developed are easily used, are responsive to changes in UP intensity, and should facilitate clinical evaluation and research to meet the needs of afflicted patients.

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Section: Discussionmentioning

confidence: 99%

“…The questionnaires included the VAS, NRS, Skindex-10, BII, Itch MOS, and the Self-Assessment of Disease Severity. The Beck Depression Index was also administered to evaluate the most common comorbid affective disorder among patients with ESRD (19,20).…”

Section: The Itch National Registry Studymentioning

confidence: 99%

A Longitudinal Study of Uremic Pruritus in Hemodialysis Patients

Mathur

Lindberg²,

Germain³

et al. 2010

Clinical Journal of the American Society of Nephrology

240

304

View full text Add to dashboard Cite

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“…Local skin effects such as calcium phosphate deposition would be expected to result in generalized pruritus or pruritus that is randomly distributed; however, bilateral symmetry in discrete non-dermatomally distributed areas is characteristic of CKD-aP. 3,38,39 Over time, the location of itching in a patient can change, but bilateral symmetry is maintained. 3 This section briefly summarizes several theories that have been the basis of treatment studies (Figure 1).…”

Section: Pathogenesismentioning

confidence: 99%

“…Subsequent non-randomized studies have yielded mixed results. One showed that a Kt/V ≥1.5 and high flux dialyzers reduced pruritus intensity, 33 whereas another study has shown an association of higher Kt/V with CKD-aP, 38 or no association between the 2 variables (Table 1). Trials examining pruritus intensity or CKD-aP prevalence in patients undergoing daily or nocturnal dialysis have not yet been performed.…”

mentioning

confidence: 99%

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

Shirazian¹,

Aina²,

Park³

et al. 2017

IJNRD

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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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“…17, 21.23 to 28 With regard to dialyzers, there are studies showing that patients dialyzed with a less permeable biocompatible membrane have more pruritus than patients dialyzed with a more permeable polysulfone membrane. 28 Others have reported that patients dialyzed with polysulfone membrane have more pruritus than those who undergo hemodialysis with hemofane and cuprofane membranes. 1 Although some studies show a relationship between these factors and pruritus, the data remain conflicting, demonstrating the need for further research on the subject.…”

Section: Introductionmentioning

confidence: 99%

Avaliação da associação entre as alterações no metabolismo mineral e o prurido nos pacientes em hemodiálise

Welter

Frainer

Maldotti

et al. 2011

An. Bras. Dermatol.

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FUNDAMENTOS: prurido é o sintoma mais freqüente nos pacientes nefropatas em hemodiálise. Parâmetros laboratoriais anormais têm sido encontrados, com dados conflitantes. OBJETIVO: relacionar a prevalência de prurido com alterações no metabolismo mineral de pacientes em hemodiálise. MÉTODOS: estudo caso-controle. Avaliados 105 pacientes, sendo os pacientes com prurido os casos, preencheram o questionário do protocolo de pesquisa e a escala análoga visual, os dados laboratoriais foram coletados dos prontuários eletrônicos. RESULTADOS: a média de idade foi de 51,9 anos, 59% dos pacientes eram homens e 43% dos pacientes tinham prurido. Xerodermia ocorreu em 45% dos pacientes. Níveis elevados de Ca foram demonstrados em 55% dos pacientes e 47% tinham prurido. Quanto ao fósforo 60% tinham valores elevados e 43% tinham prurido. A relação Ca/P foi normal em todos. O paratormônio mostrou-se elevado em 95% dos pacientes, todos referindo prurido. CONCLUSÃO: houve associação estatisticamente significativa entre o grupo de pacientes com prurido e xerodermia. Os níveis séricos de Cálcio, Fósforo, relação Ca/P, PTHi e o tamanho do dialisador não apresentaram associação estatisticamente significativa com o prurido. Logo, encontramos relação importante entre xerodermia e prurido, sem relação com os parâmetros laboratoriais avaliados.

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Uremic pruritus is associated with higher Kt/V and serum calcium concentration

Cited by 94 publications

References 0 publications

A Longitudinal Study of Uremic Pruritus in Hemodialysis Patients

A Longitudinal Study of Uremic Pruritus in Hemodialysis Patients

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

Avaliação da associação entre as alterações no metabolismo mineral e o prurido nos pacientes em hemodiálise

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