Association of uraemic pruritus with inflammation and hepatitis infection in haemodialysis patients.
BACKGROUND
Chronic inflammation and hepatitis C virus (HCV) infection have been implicated in the pathogenesis of uraemic pruritus in haemodialysis (HD) patients. However, each one's independent roles have not been previously studied.


METHODS
A total of 321 HD patients diagnosed with end-stage renal disease with maintenance HD for >3 months were included. A visual analogue scale (VAS) was used to subjectively measure the severity of itching. Based on the VAS score, patients were divided into three groups: Group 1, no pruritus (VAS = 0); Group 2, mild to moderate pruritus (VAS 0-5) and Group 3, severe pruritus (VAS >5).


RESULTS
There were 120 (37.4%) patients without any pruritus, 141 (43.9%) with mild to moderate pruritus and 60 (18.7%) with severe pruritus. Forty-six (14.3%) had hepatitis B virus (HBV) infection and 37 (11.5%) had hepatitis C virus (HCV) infection. The average serum high-sensitivity C-reactive protein (hsCRP) level was 0.58 mg/dl. Patients with severe pruritus had a significantly higher serum hsCRP level and more HBV or HCV infection (all P < 0.05). In the multi-variable logistic regression model, higher levels of hsCRP (OR = 3.54, P = 0.008) and HCV infection (OR = 2.77, P = 0.014) were both significant independent predictors for severe pruritus.


CONCLUSIONS
Our study demonstrated the heavy burden of pruritus in HD patients and corroborated the role of inflammation in the pathogenesis of uraemic pruritus. HCV infection is associated with severe uraemic pruritus but is independent of the serum hsCRP level in HD patients.
Chiu
Yen-Ling
YL
Department of Internal Medicine, Far-Eastern Memorial Hospital, Taipei County, Taiwan. yenling.chiu@gmail.com
Chen
Hung-Yuan
HY
Chuang
Yi-Fang
YF
Hsu
Shih-Ping
SP
Lai
Chun-Fu
CF
Pai
Mei-Fen
MF
Yang
Shao-Yo
SY
Peng
Yu-Sen
YS
D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000503:physiopathology; D006526:Hepatitis C / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011537:Pruritus / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D006435:Renal Dialysis; D012720:Severity of Illness Index; D014511:Uremia / Q000097:blood / Q000209:etiology* / Q000503:physiopathology
D002097:C-Reactive Protein