Pruritus in hemodialysis patients.
BACKGROUND
Pruritus is one of the most bothersome symptoms in patients on maintenance hemodialysis (HD), however little progress is seen in our understanding of its pathogenesis. The aim of this study was to evaluate the frequency of pruritus in HD patients in Tehran, Iran, and to correlate its presence and intensity with relevant clinical and laboratory parameters.


METHODS
One hundred sixty-seven patients on maintenance HD at three out-patient HD units were enrolled in the study. Itch intensity was scored as mild, moderate and severe. Some relevant clinical and laboratory parameters (age, sex, xerosis, presence of neuropathy, duration of dialysis, history of atopy and laboratory findings including hematocrit, creatinine, urea, calcium, phosphorus, parathyroid hormone [PTH] and alkaline phosphatase) were evaluated.


RESULTS
Pruritus was found in 41.9% of patients. The intensity of itching was mild, moderate and severe, in 51.4%, 11.4% and 37.7% of patients, respectively. In 22 patients (31.4%) pruritus intensified during and after dialysis. There was no significant difference in the serum levels of creatinine, blood urea nitrogen, calcium, phosphorus, alkaline phosphatase, PTH and hematocrit between patients with and without pruritus. Age, sex, xerosis, underlying renal disease, history of atopy and duration of haemodialysis were not significantly different between the two groups. However, neuropathy was significantly more common in the pruritic group (63.8% versus 42.1%) (pv = 0.006).


CONCLUSIONS
Clinical neuropathy was the only significant finding in the pruritic group in our study. This finding justifies further research on nerve function and neurotransmitters in hemodialysis patients and the introduction of new drugs targeting neuropathy.
Akhyani
Maryam
M
Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran. ma_akhyani@yahoo.com
Ganji
Mohammad-Reza
MR
Samadi
Nasrin
N
Khamesan
Behnaz
B
Daneshpazhooh
Maryam
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology; D011537:Pruritus / Q000453:epidemiology / Q000209:etiology*; D006435:Renal Dialysis / Q000009:adverse effects*; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000453:epidemiology / Q000209:etiology; D014511:Uremia / Q000150:complications*