Uremic pruritus, dialysis adequacy, and metabolic profiles in hemodialysis patients: a prospective 5-year cohort study.
BACKGROUND
Uremic pruritus is a common and intractable symptom in patients on chronic hemodialysis, but factors associated with the severity of pruritus remain unclear. This study aimed to explore the associations of metabolic factors and dialysis adequacy with the aggravation of pruritus.


METHODS
We conducted a 5-year prospective cohort study on patients with maintenance hemodialysis. A visual analogue scale (VAS) was used to assess the intensity of pruritus. Patient demographic and clinical characteristics, laboratory parameters, dialysis adequacy (assessed by Kt/V), and pruritus intensity were recorded at baseline and follow-up. Change score analysis of the difference score of VAS between baseline and follow-up was performed using multiple linear regression models. The optimal threshold of Kt/V, which is associated with the aggravation of uremic pruritus, was determined by generalized additive models and receiver operating characteristic analysis.


RESULTS
A total of 111 patients completed the study. Linear regression analysis showed that lower Kt/V and use of low-flux dialyzer were significantly associated with the aggravation of pruritus after adjusting for the baseline pruritus intensity and a variety of confounding factors. The optimal threshold value of Kt/V for pruritus was 1.5 suggested by both generalized additive models and receiver operating characteristic analysis.


CONCLUSIONS
Hemodialysis with the target of Kt/V ≥1.5 and use of high-flux dialyzer may reduce the intensity of pruritus in patients on chronic hemodialysis. Further clinical trials are required to determine the optimal dialysis dose and regimen for uremic pruritus.
Department of Dermatology, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan.
Mei-Ju
MJ
Ko
Hon-Yen
HY
Wu
Hung-Yuan
HY
Chen
Yen-Ling
YL
Chiu
Shih-Ping
SP
Hsu
Mei-Fen
MF
Pai
Ju-Yehyang
Chun-Fu
CF
Lai
Hui-Min
HM
Lu
Shu-Chen
SC
Huang
Shao-Yu
SY
Yang
Su-Yin
SY
Wen
Hsien-Ching
HC
Chiu
Fu-Chang
FC
Hu
Yu-Sen
YS
Peng
Shiou-Hwa
SH
Jee
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D055442:Metabolome / Q000502:physiology; D008875:Middle Aged; D011537:Pruritus / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism*; D006435:Renal Dialysis / Q000592:standards*; D012107:Research Design; D012720:Severity of Illness Index; D014511:Uremia / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism*