Pruritus is a common, unpleasant symptom of uremic patients. Serotonin and histamine have been reported as possible mediators of uremic pruritus, and ondansetron is a potent and selective inhibitor of 5-HT₃ receptors. The aims of our study were (1) to evaluate the effect of ondansetron on uremic pruritus in continuous ambulatory peritoneal dialysis (CAPD) patients and its safety and (2) to investigate the role of histamine and serotonin in uremic pruritus. To study the prevalence and pathogenesis of uremic pruritus, CAPD and hemodialysis (HD) patients were asked to complete a pruritus questionnaire. The replies were scored based on numerical scales, and the results were evaluated by the same investigator who did not know the patients. Pruritus was graded, according to the total points for each patient, as mild, moderate, or severe. Of 54 patients on HD, 29 (53.7%) had pruritus, and of 43 patients on CAPD, pruritus was present in 21 (48.8%). In HD patients, pruritus was mild in 14 (48.3%), moderate in 12 (41.4%), and severe in 3 (10.3%) patients; the distribution in CAPD patients was 9 (42.9%), 10 (47.6%), and 2 (9.5%), respectively. There was no correlation between the presence and severity of pruritus and age, sex, primary renal disease, duration of dialysis, dialysis solutions used, and hematological and biochemical parameters except for serum histamine and serotonin levels and their product. Plasma histamine levels in CAPD patients were 13.1 ± 1.1 ng/ml in pruritic and 11.0 ± 3.9 ng/ml in nonpruritic patients (p = 0.06), serum serotonin levels were 115.6 ± 43.3 ng/ml and 64 ± 42.3 ng/ml (p < 0.05), respectively, and the histamine × serotonin product was 1,461 ± 576 and 646 ± 545 (p < 0.01), respectively. Eleven CAPD patients (6 males, 5 females) with a mean age of 66 (range 33–83) years and an average time on CAPD of 18 (range 3–31) months with moderate to severe pruritus were treated with ondansetron (4 mg twice daily p.o.) for a mean period of 3 (range 1–5) months. All patients responded to the treatment. There was a significant reduction of the severity of pruritus from the start of treatment, and on the 3rd day the pruritic score (mean value) was 10 (range 5–19) points, while at time 0 (before treatment) it was 26 (range 19–37) points (p < 0.0001). Pruritus disappeared in 7 patients at the end of the 1st week and in all patients at the end of the 2nd week of treatment. This effect was maintained during the study. Plasma histamine levels decreased significantly during the treatment from 12.9 ± 1.2 to 6.7 ± 5.9 ng/ml (p < 0.05). Also, serum serotonin levels were reduced from 125.1 ± 47.8 to 59.3 ± 27.5 ng/ml (p < 0.05) at the end of the 1st month of treatment, and the histamine × serotonin product showed a more significant reduction: from 1,544 ± 656 to 454 ± 436 (p < 0.01). Three patients reported an improvement in their nausea and vomiting during the treatment. Weekly clinical and laboratory examinations showed no side effects, adverse reactions, or other complications. Our data indicate that o...

SummaryBackground and objectives Uremic xerosis is a bothersome condition that is poorly responsive to moisturizing and emollient therapy.Design, setting, participants, & measurements A randomized, double-blind, intraindividual (left versus right comparison), multicentric clinical study was performed on 100 patients with moderate to severe uremic xerosis for 7 days, during which the patients applied twice daily an emulsion combining glycerol and paraffin (test product) on one allocated lower leg, and the emulsion alone (comparator) on the other lower leg. This was followed by an open-labeled use of the test product on all of the xerotic areas for 49 days. The main efficacy parameter was treatment response on each lower leg, as defined by a reduction from baseline of at least two grades in a five-point clinical score on day 7.Results Among the 99 patients analyzed, the test product was highly effective with a treatment response in 72 patients (73%), whereas 44 patients (44%) responded to the comparator (P Ͻ 0.0001, intergroup analysis). This was associated with an objective reduction in the density and thickness of the scales on day 7 (P Ͻ 0.0001 compared with the comparator) and a substantial improvement of the uremic pruritus (75%) and quality of life of the patients at study end (P Ͻ 0.001, intragroup analysis). The test product was very well tolerated, with product-related local intolerance (exacerbated pruritus, local burning, or erythema) occurring in only five patients (5%).Conclusions Uremic xerosis can be managed successfully when an appropriate emollient therapy is used.

To study the prevalence and pathogenesis of uremic pruritus, CAPD and HD patients were asked to complete a questionnaire. The replies were quantitated based on numerical scales, and the results were compared with various hematological and biochemical parameters, underlying disease, and duration of dialysis. There were 113 CAPD patients (63 males and 50 females), mean age 60 (range 20–84) years, average time on CAPD 20 (range 1–163) months and 76 HD patients (44 males and 32 females) mean age 57 (range 23–81) years, mean time on HD 44 (range 2–242) months. Replies to questions were evaluated and graded by the same Investigator who did not know the patients. Pruritus was present in 70 (62%) CAPD patients (64% in females and 600/0 in males p=NS) and in 41 (54%) HD patients (69% in females and 43% in males, p=0.025). Before starting dialysis pruritus was present in 30% CAPD patients and 28% HD patients. Pruritus was graded as mild, moderate and severe; the distribution was 58.6%, 34.3%, and 7.1% (CAPD) and 43.90/0, 41.5%, and 14.6% (HD), respectively. Dry skin was reported by 73% CAPD patients and 72% HD patients. This xerodermia was correlated with the severity of pruritus and was also present In 65% CAPD and 48.5% HD patients without pruritus. Patients with pruritus were older than those without pruritus both for CAPD (63 vs 54 years, p=0.004) and HD (61 vs 51 years, p=0.003). A significant correlation was observed only between pruritus score and age for CAPD patients. There were no other correlations between pruritus and the other parameters studied. We conclude that pruritus Is a frequent symptom In dialysis patients, but It Is severe only In a small proportion. Its prevalence, as also that of dry skin, Increases after start of dialysis and Is higher In females on HD. Patients with pruritus are older, and the severity of pruritus correlates with age in the CAPD patients. Presence of dry skin correlates with severity of pruritus, and Its prevalence Is high even among patients without pruritus.

This study reports our experience with permanent peritoneal catheters. From July 1983 until December 1997, 225 catheters were implanted surgically in 207 patients (120 males, 87 females) with mean age of 58 ± 16 years (range: 2 -82 years), and a mean duration of continuous peritoneal dialysis (CAPD) of 21.9 ± 21.3 months (range: 1 145 months). Two hundred and seventeen catheters were used in 199 patients suffering from end-stage renal disease (ESRD), and 8 catheters in 8 patients with end-stage heart failure resistant to medical therapy. One patient used 3 catheters and 16 patients used 2 catheters. The catheters used were: Tenckhoff, 2; Oreopoulos Zellerman-1 (OZ-1), 10; OZ-2, 205; and OZ-pediatric, 8. All catheters were implanted by the same surgical team, through a paramedian incision under local anesthesia. By life table analysis, the actuarial survival rates at 1 year, 2 years, 3 years, and 5 years were 97%, 92%, 87%, and 82% respectively for all catheters. The catheter-related complications were: 5 obstructions, 2 dislodgments, 13 dialysate leaks (6 early; 7 late), 90 exit-site/tunnel infections (in 56 patients), 2 cuff extrusions, and 37 hernias (in 31 patients). Eighteen catheters were replaced for persistent peritonitis (15 cases), dislodgment (1 case), obstruction (1 case), and accidental shortening (1 case). The total observation period was 4526 patient-months. The overall incidence of peritonitis was one episode per 15 patient-months, and of exit-site/tunnel infections was one episode per 50 patient-months, with a significant improvement during the last years. We conclude that OZ catheters implanted surgically through a paramedian incision have a very high survival rate and a low complication rate.