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

Abstract

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.

Total Calcium and Albumin Are Decreased in the Deeper Epidermis of Patients with Chronic Kidney Disease-Associated Pruritus

“…This population has also demonstrated a greater incidence of hepatitis C infections [19] and higher CRP levels [20] than HD patients without CKD-aP. Combined with the fact that the disease tended to decrease blood albumin concentration, the results suggest a relationship between CKD-aP and low albumin levels.…”

Hemodialysis‐related pruritus and associated cutaneous manifestations

“…It can be a presenting symptom of hepatitis C 19 . Interestingly, in uremic patients undergoing peritoneal dialysis, viral hepatitis is associated with a higher prevalence and a higher intensity of pruritus 20 . To our knowledge, the relationship between uremic pruritus in HD patients and hepatitis C has not been studied previously.…”

“…16 -18 It can be a presenting symptom of hepatitis C. 19 Interestingly, in uremic patients undergoing peritoneal dialysis, viral hepatitis is associated with a higher prevalence and a higher intensity of pruritus. 20 To our knowledge, the relationship between uremic pruritus in HD patients and hepatitis C has not been studied previously. Because we do not have previous comparative data, we can not rule out the possibility that the presence of hepatitis C plays some role in stimulating uremic pruritus.…”

Hepatitis C virus-associated pruritus: Etiopathogenesis and therapeutic strategies

“…In addition to hepatic damage, chronic hepatitis C virus (HCV) infection is associated with the development of extrahepatic manifestations, particularly, cutaneous-based disorders including pruritus[ 1 , 2 ]. The occurrence of pruritus is associated with skin disorders ( e.g ., atopic dermatitis and psoriasis) as well as chronic liver disease[ 3 , 4 ]. Pruritus is a the common dermatologic manifestations that is recognized as an early sign of chronic HCV infection[ 5 , 6 ], particularly infections associated with the development of cholestasis[ 7 ].…”