A Longitudinal Study of Uremic Pruritus in Hemodialysis Patients

Mathur, Vandana; Lindberg, Jill S.; Germain, Michael J.; Block, Geoffrey A.; Tumlin, James A.; Smith, Martin; Grewal, Manpreet Kaur; McGuire, Dawn

doi:10.2215/cjn.00100110

Cited by 265 publications

(352 citation statements)

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“…The link between hyperparathyroidism and pruritus originates from early reports of improvement in itching after parathyroidectomy (26,27). However, many patients with severe pruritus do not have elevated PTH levels (11), and no association has been shown between pruritus and PTH in this study and other studies (2,20,24).…”

Section: Discussionmentioning

confidence: 44%

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International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

Rayner¹,

Larkina²,

Mia³

et al. 2017

CJASN

190

238

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Background and objectives Uremic pruritus in patients on hemodialysis is associated with depression, lower quality of life, and mortality. We studied the prevalence, awareness, and treatment of pruritus to assess how well this important condition is currently managed internationally.Design, setting, participants, & measurements Data from 35,452 patients on hemodialysis in up to 17 countries from the Dialysis Outcomes and Practice Patterns Study were analyzed to describe pruritus prevalence from 1996 to 2015. Data from 6256 patients and 268 medical directors in 17 countries in 2012-2015 were analyzed to describe predictors, effects, medical directors' awareness, and treatment of pruritus.Results Patients very much or extremely bothered by itching declined from 28% in 1996 to 18% in 2015. In 2012-2015, among patients nearly always or always bothered by itching, pruritus had a major effect on work and social life; 18% used no treatment for pruritus, and 17% did not report itching to health care staff. In total, 69% of medical directors underestimated the prevalence of pruritus in their unit. Managing high serum phosphorus and low Kt/V was ranked as the most important intervention, but no relationship was found between these factors and pruritus; 57% of medical directors used oral antihistamines for first-line chronic treatment of pruritus. Gabapentin was used by 45% as first-, second-, or third-line treatment. Nalfurafine was only used in Japan.Conclusions The prevalence of pruritus in people on hemodialysis is decreasing but remains underestimated. Large numbers of patients on hemodialysis with severe pruritus do not receive treatment. There is wide variation in the use of unlicensed medications for the treatment of pruritus. These data provide a benchmark for initiatives to improve the management of uremic pruritus.

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Section: Discussionmentioning

confidence: 44%

“…Furthermore, an association between these measures and pruritus is no longer observed in the 2012-2015 data, a finding supported by other recent studies (11,20,24). There is no published interventional study showing that lowering serum phosphorus improves pruritus.…”

Section: Discussionmentioning

confidence: 73%

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

Rayner¹,

Larkina²,

Mia³

et al. 2017

CJASN

190

238

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“…Factors, increasing severity of pruritus can be; decreasing level of estrogen and subcutaneous adipose tissue with increasing age in women (23). In the studies, it was also explored that men who received dialysis for long time, those with dry skin, the elderly people, those living in the rural area, those not following diet programs, those subjected to hot weather and wearing wool clothes suffered from pruritus more (11)(12)(13)19).…”

Section: No 9 182 Türk Nefroloji Diyaliz Ve Transplantasyon Dergisimentioning

confidence: 99%

An Important Problem Among Hemodialysis Patients: Uremic Pruritus

Akça¹,

Taşçı²

2014

Turk Neph Dial Transpl

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ObJECTIVE: This study was conducted in order to determine the incidence of uremic pruritus in hemodialysis patients and to explore the associated factors. MATErIAL and METHODS:This descriptive study included 204 patients. Official permissions from the institutions and informed consents of the patients were obtained. The data were gathered using a questionnaire form designed by the investigators and the Visual Analogue Scale (VAS). The t test, one-way ANOVA and logistic regression analysis were used for the statistical analyses of the data. rESULTS:We found that 75.5% of the patients suffered from pruritus after hemodialysis treatment was initiated and 64.2% of them had an average level of pruritus (6.0±2.0) at the time of the study. It was noted that 37.4% had wounds caused by pruritus and 61.1% woke up from their sleep due to pruritus. Patients who were aged ≥ 65 were 3.91 times more likely to suffer from very severe pruritus compared to other age groups and patients with dry skin were 9.90 times more likely to suffer from very severe pruritus as compared to those with normal skin (p<0.05) CONCLUSION:In light of these results, it may be recommended that patients who suffer from uremic pruritus should be provided with the necessary care and training programs, taking into account their individual and disease-related characteristics. KEy wOrDS: Uremic pruritus, Hemodialysis, Affecting factorsÖz AMAÇ: Bu çalışma, hemodiyaliz tedavisi alan bireylerin yaşadığı üremik kaşıntı ve kaşıntıyla ilişkili faktörleri belirlemek amacıyla yapılmıştır. GErEÇ ve yÖNTEMLEr:Tanımlayıcı nitelikte yapılan bu çalışma, araştırmaya katılmayı kabul eden 204 kişi üzerinde yapılmıştır. Çalışmada, kurum izni ve bireylerden yazılı onam alınmıştır. Veriler araştırmacılar tarafından oluşturulan anket formu ve Visual Analog Skala (VAS) aracılığı ile toplanmıştır. Verilerin istatistiki değerlendirilmesinde, Student t, ANOVA testi ve lojistik regresyon analizi kullanılmış ve p<0.05 anlamlı olarak kabul edilmiştir.bULGULAr: Bireylerin %75,5'inin hemodiyaliz tedavisine başladıktan sonra kaşıntısının olduğu, %64,2'sinin ise çalışmanın yapıldığı anda ortalama 6,0±2,0 (2-10) düzeyde (şiddetli) kaşıntı yaşadıkları saptanmıştır. Bireylerin %37,4'inin kaşıntı sonucu vücudunda yaralar olduğu ve %61,1'inin kaşıntı nedeniyle uykusundan uyandığı belirlenmiştir. Diğer yaş gruplarıyla karşılaştırıldığında 65 yaş üstü hastaların 3,91 kat ve derisi kuru olan hastaların ise derisi normal olanlara göre 9,90 kat daha şiddetli kaşıntı yaşadığı tespit edilmiştir (p<0,05). SONUÇ:Bu sonuçlar doğrultusunda, üremik kaşıntı yaşayan bireylerin bireysel ve hastalık özellikleri dikkate alınarak eğitim ve bakım yapılması önerilebilir.

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“…Approximately 60-80% of patients undergoing hemodialysis have pruritus, and many cases are refractory to treatment [1][2][3][4][5][6][7][8]. Moreover, degree of itchiness and sleep disorders are strongly correlated.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of the Japanese version of the 5-D itch scale for rating pruritus experienced by patients undergoing hemodialysis

et al. 2018

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Background: Pruritus in patients undergoing hemodialysis reduces quality of life via insomnia and depression, and negatively affects prognosis. For diagnosing pruritus, selecting therapeutic strategies, and determining therapeutic outcomes, methods are needed for objectively quantifying the degree of itchiness. In 2015, the Japanese version of the 5-D itch scale (5D-J), originally developed in the USA in 2010, was developed as a simple self-administered questionnaire; it evaluated the degree of itchiness based on five components: (1) duration of itchiness, (2) degree of itchiness, (3) direction of itchiness, (4) disability caused by itchiness, and (5) distribution of itchiness. 5D-J is useful for comprehensively assessing multiple elements related to itchiness. We used 5D-J to assess the degree of itchiness experienced by patients undergoing hemodialysis to investigate its clinical usefulness. Methods: Subjects were 336 patients undergoing maintenance hemodialysis at our facility in October 2016; they were selected from 383 patients, of whom 20 were excluded because their itchiness had a dermatologic origin and 27 were excluded because their localized itchiness was related to vascular access, respectively. The status of itchiness (duration, degree, direction, disability, and distribution) of the patients was surveyed in October 2016 using 5D-J; total scores were calculated and used for assessing the itchiness experienced by patients. We additionally investigated whether 5D-J scores correlated with visual analog scale (VAS) and Shiratori severity scores for pruritus. Results: Degree was reported as "not present" by 124 patients (36.9%), "mild" by 164 (48.8%), "moderate" by 46 (13.7%), "severe" by 2 (0.6%), and "unbearable" by 0 (0%). Total score was 5 points in 55 patients (16.4%), 6-9 in 176 (52.4%), 10-14 in 95 (28.3%), 15-19 in 9 (2.7%), 20-24 in 1 (0.3%), and 25 in 0 (0%). The 5D-J total and VAS scores were strongly correlated (r = 0.7159; p < 0.001). The 5D-J total score correlated with "daytime itchiness" (r = 0.6441; p < 0.001) and "nighttime itchiness" (r = 0.6352; p < 0.001) on the Shiratori severity score. Conclusions: 5D-J may be useful for objectively assessing itchiness experienced by patients undergoing hemodialysis.

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A Longitudinal Study of Uremic Pruritus in Hemodialysis Patients

Cited by 265 publications

References 18 publications

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

An Important Problem Among Hemodialysis Patients: Uremic Pruritus

Usefulness of the Japanese version of the 5-D itch scale for rating pruritus experienced by patients undergoing hemodialysis

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