Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges

Shirazian, Shayan; Aina, Olufemi; Park, Youngjun; Chowdhury, Nawsheen; Leger, Kathleen; Hou, Linle; Miyawaki, Nobuyuki; Mathur, Vandana

doi:10.2147/ijnrd.s108045

Cited by 111 publications

(108 citation statements)

References 102 publications

(142 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For duration, 91.4% of the patients reported < 6 h/day. For degree, 63.1% reported mild or more severe itchiness, which is comparable to the 60-80% previously reported [1][2][3][4][5][6][7][8]. However, 14.3% of the patients in our study reported moderate or more severe itchiness, which was lower than the 30-50% previously reported [1][2][3][4][5][6][7][8].…”

Section: Discussionsupporting

confidence: 55%

See 1 more Smart Citation

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

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 55%

“…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

View full text Add to dashboard Cite

show abstract

“…It can be acute or chronic, resulting from xerosis or eczema, cirrhosis, hematologic disorders, infection, or drug reactions. Pruritus is one of the most distressing symptoms in chronic kidney disease (CKD) [2] also termed, "CKD associated pruritus" (CKD-P) [3]. Uremic pruritus is extremely common in patients undergoing hemodialysis [4,5].…”

Section: Introductionmentioning

confidence: 99%

Skin Cutibacterium acnes Mediates Fermentation to Suppress the Calcium Phosphate-Induced Itching: A Butyric Acid Derivative with Potential for Uremic Pruritus

Keshari

Wang

Herr

et al. 2020

JCM

View full text Add to dashboard Cite

Pruritus and inflammation associated with accumulation of calcium phosphate (CaP) under the skin are common problems among dialysis patients with chronic kidney disease (CKD). The role of skin commensal microbiota in the CaP-induced uremic pruritus remains uncharacterized. Skin Cutibacterium acnes (C. acnes) can solubilize CaP by the production of short-chain fatty acids (SCFAs), such as butyric acid, through glucose fermentation. Like butyric acid, the N-[2-(2-Butyrylamino-ethoxy)-ethyl]-butyramide (BA-NH-NH-BA), a butyric acid derivative, remarkably induced acetylation of histone H3 lysine 9 (AcH3K9) in keratinocytes. Topical application of fermenting C. acnes, butyric acid or BA-NH-NH-BA onto mouse skin effectively ameliorated CaP-induced skin itching, interleukin (IL)-6 up-regulation in keratinocytes, and extracellular signal-regulated kinase (ERK) 1/2 activation in dorsal root ganglia (DRG). Activation of ERK 1/2 by CaP was markedly reduced in IL-6 knockout mice. Genus Cutibacterium was detected in relatively low abundance in itchy skin of patients with CKD. Our results identify a role for the skin fermenting C. acnes in ameliorating CaP-induced activation of IL-6/p-ERK signaling and resulting skin inflammation. Furthermore, we provide evidence for the potential therapeutic efficacy of BA-NH-NH-BA as a postbiotic for the treatment of uremic pruritus.

show abstract

“…11 These complications include hyperphosphatemia, which increases the risk of cardiovascular events, bone mineral disorders, secondary hyperparathyroidism, 12 sleep disorders 13 and pruritus, impacting HRQOL in several dimensions. 14 Given the above, it is emphasized that the nurse in a Renal Unit has competence and concrete possibilities to intervene with these patients, in order to provide knowledge that favors adherence to treatment, reducing the harmful effects of the disease on the body and the evaluation of their HRQoL. Among the activities that nurses can perform are educational nursing interventions.…”

Section: Introductionmentioning

confidence: 99%

Effect of Educational Intervention on the Quality of Life of Hyperphosphathemic Chronic Renal Patients on Hemodialysis

Stumm

Benetti²,

Pretto

et al. 2019

Texto contexto - enferm.

View full text Add to dashboard Cite

Objective: to evaluate the health-related quality of life of hyperphosphatemic chronic renal patients on hemodialysis before and after a nursing educational intervention. Method: a quasi-experimental before-and-after study, conduted with 63 hyperphosphatemic chronic renal patients from a renal unit of the state of Rio Grande do Sul (Brazil). A sociodemographic and clinical characterization form was used, pruritus intensity record, Kidney Disease Quality of Life - Short Form and Nursing Educational Intervention. This included individual guidance, clarification of doubts and a printed manual. Laboratory data and pruritus evaluated before, 30 and 60 days after intervention, and quality of life, before and after two months. Analysis from descriptive and analytical measures. Results: after the intervention, there was a statistical difference between the mean scores of the following dimensions: Physical function, Emotional function, Energy/Fatigue, List of problems/symptoms and Cognitive function. Significant correlation was found in the following dimensions: Physical functioning, Physical function, Pain, General health, Emotional wellbeing, List of problems/symptoms, Effects of kidney disease, Kidney disease overload, Sleep and stimulation by the dialysis team. With the intervention there was a reduction in phosphorus, creatinine, calcium and parathyroid hormone levels. Itching also decreased. Regarding the evaluation of their health, 31.7% considered it “good” and 58.8% “regular” before the intervention; afterwards, 50.8% and 36.5% rated it as “good” and “fair” respectively. Conclusion: nursing educational intervention improves health-related quality of life and health perception of hyperphosphatemic chronic renal patients on hemodialysis.

show abstract

Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges

Cited by 111 publications

References 102 publications

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

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

Skin Cutibacterium acnes Mediates Fermentation to Suppress the Calcium Phosphate-Induced Itching: A Butyric Acid Derivative with Potential for Uremic Pruritus

Effect of Educational Intervention on the Quality of Life of Hyperphosphathemic Chronic Renal Patients on Hemodialysis

Contact Info

Product

Resources

About