The impact of dialysis modality on skin hyperpigmentation in haemodialysis patients.
BACKGROUND
Skin hyperpigmentation in end-stage renal disease (ESRD) patients has been attributed to the accumulation of middle-molecular-weight (MMW) substances. Although an MMW mechanism suggests that hyperpigmentation may be improved by high-flux haemodialysis (HF-HD) and haemodiafiltration (HDF), this possibility has not been explored. In the present study, we investigated the impact of different dialysis modalities on skin colour in HD patients.


METHODS
Eighty-two ESRD patients on HD were divided into low-flux HD (LF-HD), HF-HD and HDF groups. The melanin index (MI) and erythema index (EI) of the abdomen and the flexor side of the forearm (non-sun-exposed areas) and the forehead (sun-exposed area) were determined by using a narrow-band reflectance spectrophotometer at baseline and after 12 months.


RESULTS
Even though absolute values of baseline and follow-up MI and EI of the three sites were comparable among the three groups, forehead MI and EI were significantly decreased after 12 months in the HDF group (P < 0.05). In addition, the change in forehead MI was significantly greater in the HDF than in the LF-HD group (-1.0 +/- 2.4% versus 0.3 +/- 1.6%, P < 0.05). Moreover, beta(2)-microglobulin reduction rates were negatively correlated with both changes in forehead MI (P < 0.01) and EI (P < 0.05).


CONCLUSIONS
Skin colour of sun-exposed areas was signi- ficantly decreased in ESRD patients receiving HDF therapy, suggesting that enhanced removal of MMW substances by convection may prevent or reduce hyperpigmentation in HD patients.
Moon
Sung Jin
SJ
Department of Internal Medicine, Yonsei University, Seoul, Korea.
Kim
Dong Ki
DK
Chang
Jae Hyun
JH
Kim
Chan Ho
CH
Kim
Hyun Wook
HW
Park
Sun Young
SY
Han
Seung Hyeok
SH
Lee
Jung Eun
JE
Yoo
Tae-Hyun
TH
Han
Dae Suk
DS
Kang
Shin-Wook
SW