Cutaneous Manifestations in Patients with Chronic Kidney Disease on Maintenance Hemodialysis

Abstract

Cutaneous disorders can precede or follow the initiation of hemodialysis treatment. We evaluated the prevalence of various dermatological manifestations in patients undergoing hemodialysis at least twice a week for minimum of three months at our center. Patients were excluded if they were undergoing hemodialysis less than twice a week or on hemodialysis secondary to ESRD following graft dysfunction. One hundred and forty-three patients were evaluated. Among them, there were 113 male and 30 females. Among the skin changes, pruritus accounted for 56%, Xerosis was observed in 52%, Diffuse blackish hyper pigmentation was seen in 40%. Skin infections was seen in 53% of patients, of these fungal, bacterial and viral infections were 27.2%, 14.6%, and 11.2%, respectively. Kyrle's disease was observed only in 6.9%. Other skin manifestations include eczema 4.8%, psoriasis 2.7%, and drug rash 2.1%. Nail changes were observed in 46 patients of whom 27 patients had onychomycosis. Other changes include discoloration, onycholysis, and splinter hemorrhages. Hair changes were observed in 21.7%. Mucosal changes were seen in 27.3%. In our study, pruritus, xerosis, and pigmentation were higher among skin changes. Recognition and management of some of these dermatological manifestations vastly reduce the morbidity and improve the quality of life.

Cutaneous manifestations in chronic renal failure patients on hemodialysis and medical management

“…However, we observed it only in 17%. 10,11 Frequency as low as 8% has also been reported by Pico et al 3 Perforating disorders, combining the characteristics of Kyrles disease and perforating folliculitis can be found in CRF and diabetes mellitus. In our study this finding was observed in 7.5% of the patients of the patients, while Kolla et al reported a prevalence of 6.9%.…”

“…Hajheydari et al, reported hair changes in 38% of the patients in their study. 10 Udaykumar et al reported hair changes in 27% of their patients. 12 Mucosal changes are common in patients with CKD and can be due to dehydration, mouth breathing, high concentration of urea and failure to breakdown to ammonia.…”

“…In our study, pruritus was found in 46.7% of the patients, which is comparable to studies by Pico et al and Hajheydari et al who reported pruritus in 38.8% of patients in their study. 2,3,10 It was also more common among CKD patients on medical management. The occurrence of pruritus was however found to be independent of duration and severity of CKD, in our study.…”

“…But in other studies the patients were slightly younger. 10 The average duration of CKD at the time of presentation was 38.9 months. The study population had a mix of mild, moderate and severe cases.…”

A study of cutaneous manifestations in chronic kidney disease patients on hemodialysis

“…Hyperpigmentation was seen in 30 (25%) patientswhich was similar to various other studies 11 . Failure of the kidneys to secrete beta-melano-stimulating hormone resulting in increased deposition of melanin in the skin has been implicated for this 12 . Pallor was seen in 20 (16.6%) of the patients and all these patients had a hemoglobin <6gm/dl.…”