Factors associated with pruritus uremic in chronic kidney failure patients
Keywords:
Pruritus uremic, chronic kidney disease, acute kidney diseaseAbstract
Objective Uremic pruritus is one of the most distressing symptoms in patients with chronic renal failure. Interestingly, pruritus is not typically found in acute renal failure. Etiology and pathogenesis of uremic pruritus remain unclear. Several studies have demonstrated controversial results. Our study evaluated the frequency and intensity of uremic pruritus in patients with chronic renal failure (CRF) on hemodialysis including its associated factors. The aim of our study was to determine etiology and pathogenesis of uremic pruritus. Methods The study was a cross-sectional study conducted at Dr. Kariadi Hospital in Semarang city involving 33 hemodialysis patients between June and November 2005. About 6 cc of blood volume was withdrawn from each patient before the patient undergoing hemodialysis. Laboratory findings including blood urea, parathyroid hormone, calcium, phosphate, magnesium, vitamin A, and interleukin 2 levels were evaluated. Patient were be interviewed and examined if they had other diseases that may also cause pruritus. Results Uremic pruritus was found in 75.8% of the patients. Uremic pruritus had no correlation with urea level; secondary hyperparathyroidism, elevated divalent cations levels such as calcium, phosphate, magnesium levels as well as with hypervitaminosis A, interleukin-2 level or any group of those variables. On the other hand, uremic pruritus correlated to concomitant diseases. The intensity of uremic pruritus was related to the duration of hemodialysis. Conclusion Multifactorial facets could be involved in the pathogenesis of uremic pruritus. Further experiments are required to reveal greater details regarding the pathogenesis of uremic pruritus.References
Inbar Z, Yosipovitch G, David M, Uzi G. Prevalence and characterization of uremic pruritus is still a mayor problem for patients with end-stage renal disease. J Am Acad Dermatology 2003; 49; 5
Szepietowski Jc, Sikora M, Krustal M. Uremic pruritus : A clinical study of maintenance hemodialysis patients. J Dermatol 2002; 29(10); 621-627
Rayner HC, Larkina M, Wang M, et all. International comparisons of prevalence, awareness, and treatmentof pruritus in people on hemodialysis. Clin J Am Soc Nephrol 2017; 18
Germain MJ. Uremic pruritus: An itch with ominous consequences.Am J Nephrol 2017; 46; 448-9
Forrestel AM, Micheletti RG. Skin manifestations of internal organ disorders. Fitzpatrick’s Dermatology 9th Ed. New York:Mc Graw-Hill: 2019. p. 2436
Nurley JR, Elston DM, Hogan DJ, et all. Dermatologic manifestation of renal disease. Update April 11th 2012. Available at: www.emedicine.com
Virga G. Pruritus in Hemodialysis Patients 3rd Congress of nephrology in internet. CIN 2013
Perhada V, Gruber F, Kastelan M, et all. Pruritus an important symptom of internal diseases. Dermatovenereologica 2000; 9; 3
Ashmore SD. Ondestron therapy for uremic pruritus in hemodialysis pruritus. American Journal of Kidney Disease 2000; 35(5); 827-831
Odom RB, James WD, Berger TG. Pruritus and neurocutaneousdermatosis. Andrew’s Diseases of The Skin 9th ed. Philadelphia: WB Saunders Company 2000; p: 49-68
Stahle-Backdah. Pruritus clinical aspects. The cause of uremic pruritus is unknown. Dermatol 2002; 14:297-301. Available at www.cheus.ubc.ca/pruritus.pdf
Mettang T, Magnus CP, Alscher DM. Uraemic pruritus new perspectives and insights from recent trials. European Renal Association Dialysis and Transplant Association. Nephrology dialysis transplant 2002; 17; p. 1558-1563.
Aresi G, Hugh C, Hassan L, et all. Reasons for underreporting of uremic pruritus in people with chronic Kidney disease: A qualitative study. Journal of Pain and Symptom Management 2019; 58; 578-86
Aramwit P, Supasyndh O. Uremic pruritus; Its prevalence, pathophysiology and management. Intech Open Sci 2015; 19-41
Swarna SS, Aziz K, Zubair T, et all. Pruritus associated with chronic kidney disease: A comprehensive literature review. Cureus 11(7):e5256. DOI 10.7759/cureus.5256
Twycross R, Greaves MW, Handwerker H, et all. Itch: Scarthing more than the surface. QJ Med 2003; 96; 7-26
Scoot M. Renal Failure associated pruritus: Uremic pruritus. A family medicine resource. Update 5/10/2008. Available at: www.familypracticenotebook.com
Nowak M, Tsoukas M, Deimus A. Generalized pruritus without primary lesions. Postgraduate medicine, February 2000; 107; 2
Lupi O, Sessim M, Duarte DJ, et all. Cutaneous manifestations in end-stage renal disease. An Bras Dermatol 2011; 86(2); 319-26
Blaine J, Chochol M, Levi M. Renal control of calcium, phosphate, and magnesium homeostasis. Clinical Journal of The American Society of Nephrology; 2015; 10(7) 1257-72
Nigam SK, Bush KT. Uraemic syndrome of chronic kidney disease: altered remote sensing and signaling. Nature reviews Nephrology 2019;
Schmidt TJ. Physiological functions of corticosteroids. In: Lin AN, Paget SA eds. Principles of corticosteroid therapy. London: Arnold, 2002: 19-40
Combs SA, Teixeira JP, Germain MJ. Pruritus in Kidney Disease. Seminars in nephrology 2015; 35; 383-91
Arnat K, Bowens KE. Pruritus. Manual of dermatologic therapeutics 6th Ed. Philadelphia: Lippincott Williams & Wilkins 2002; 166-72
Filippi CD, Regazzini R, Piazza V, et all. Uremic pruritus is not related to plasma histamine concentrations. Clin Exp Dermatol 1995; 20; 294-6
Henrich WL. Uremic pruritus. Up to date patient information. Society of general internal medicine. April 2005. Available at http://www.patients.update.com.topic.asp
Shaw DM, Merien F, Braakhuis A, Dulson D. T-cells and their cytokine production: The anti-inflammatory and immunosuppressive effects of strenuous exercise. Cytokine 2018; 104; 136-42
Braun-Falco O, Plewig G, Wolf HN, Burdorf WHC. Pruritus, prurigo, self induced disease, psychiatric disease and neurologic disease. Dermatology second completely, revised edition. Berlin: Springer-Verlac 2000; 989-1012
Scott M. Pruritus. Journal of American family physician 2003; 68; 1135-42
Mollaoglu M. Depression and health-related quality of life in hemodialysis patients. J Dial & Trans 2004; 3; 9
Koo JR, Yoon JW, Kim SG, et all. Assosiation of depression with malnutrition in chronic hemodialysis patients. Am J Kidney Dis 2003; 41;1037-42
