Efficacy of acupoint stimulation as a treatment for uremic pruritus: A systematic review and meta-analysis

Abstract

BackgroundUremic pruritus causes sleep disturbances, poor quality of life, and increased morbidity in patients with chronic kidney disease. Acupuncture has been shown to improve uremic pruritus. There is limited evidence of the efficacy of traditional Chinese therapies. We conducted a systematic review and meta-analysis to evaluate the efficacy of acupoint stimulation therapy in patients with uremic pruritus.MethodsA systematic search of seven databases (up to Sep 2022) was conducted for randomized controlled trials that evaluated the clinical efficacy of acupuncture, acupressure, auricular acupressure, acupoint injection, acupoint thermal therapy, acupoint sticking therapy, or transcutaneous electrical acupoint stimulation in the treatment of patients with uremic pruritus. Two reviewers selected eligible articles for inclusion in the meta-analysis and evaluated the risk of bias via Cochrane Collaboration. The results of pruritus assessments and uremic pruritus-related laboratory parameters were analyzed.ResultsForty trials published between 2002 and 2022, including a total of 2,735 participants, were identified for inclusion in the meta-analysis. The effective rates for acupuncture, auricular acupressure, and the combination of acupoint injection and acupoint massage were significantly greater in patients with uremic pruritus compared to the control group. The levels of serum BUN, PTH, and histamine levels were significantly lower vs. control group.ConclusionsAcupuncture, auricular acupressure, and the combination of acupoint injection and acupoint massage seem to be effective in improving uremic pruritus in patients with chronic kidney disease. However, further investigation of these potential treatments is now warranted in larger patient populations and over a longer time frame.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022354585, identifier: PROSPERO CRD42022354585.

An Apriori algorithm-based association rule analysis to identify acupoint combinations for treating uremic pruritus

“…Acupoint stimulation has been shown to play a significant role in improving UP, according to the meta-analysis from which this study was derived[ 11 ]. In addition, this study revealed the three core combinations of acupoint stimulations commonly used to treat UP: (Auricular shenmen [TF4], Quchi [LI11] and Geshu [BL17]), (Auricular heart [Extra14], Sanyinjiao [SP6] and Auricular lung [CO14]), and (Auricular heart [Extra14], Xuehai [SP10], and Auricular lung [CO14]).…”

“…The analysis stemmed from a previous meta-analysis conducted previously on 40 RCTs examining the efficacy of acupuncture in treating UP[ 11 ]. Acupoints for acupuncture and associated manipulation (acupressure, acupoint thermal therapy, auricular acupressure, acupoint sticking therapy TEAS, or acupoint injection) were extracted from the included RCTs published between 2002 and 2022.…”

“…Overall bias was scored high, unclear, or low. A detailed description of this quality assessment has been provided previously[ 11 ].…”

“…Complementary alternative medicines, including Chinese herbal bath therapy and acupuncture, have been shown to have fewer adverse drug reactions compared with Western medicine[ 8 ]. In previous systematic reviews and randomized controlled trials (RCTs), acupoint stimulation techniques, such as acupuncture, acupressure[ 9 , 10 , 11 ], auricular acupressure[ 12 ], and transcutaneous electrical acupoint stimulation (TEAS)[ 13 ], have been identified as safe and effective alternative therapies for reducing the itching sensation. A possible mechanism of alleviating pruritus involves regulating mast cell degranulation, reduction of histamine release, and endogenous opiate-like substance stimulation[ 8 , 12 ].…”

“…Apriori, an algorithm belonging to the category of association rule mining techniques, functions by detecting the presence of item sets within extensive databases and subsequently formulates corresponding association rules utilizing metrics such as support, lift, and confidence[ 18 ]. Due to the lack of research on the use of acupoint combinations and standardized criteria, this study used an Apriori association rule analysis utilized data derived from the meta-analysis encompassing 40 RCTs to explore potential core acupoint combinations that were utilized in acupuncture and related techniques to treat UP[ 11 ].…”