Longitudinal Predictors of Uremic Pruritus

Shirazian, Shayan; Kline, Myriam; Sakhiya, Vipul; Schanler, Mary; Moledina, Dennis G.; Patel, Chinmay; Hazzan, Azzour D.; Fishbane, Steven

doi:10.1053/j.jrn.2013.08.002

Cited by 36 publications

(22 citation statements)

References 9 publications

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“…With regards to UP characteristics, our results found that severe pruritus was observed in the studied population, as represented by a median VAS of 7 (5-8), according to the adopted classification in previous studies [9,17,20]. It is important to note that some studies have found an increased mortality risk in patients undergoing dialysis associated with severe pruritus, e.g., when the pruritus VAS score was greater than 7 [17,21].…”

Section: Discussionsupporting

confidence: 52%

Factors associated with uremic pruritus

et al. 2017

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Background: The etiopathogenesis of uremic pruritus (UP) is multifactorial aspect, and it is thus necessary to elucidate its associated factors to develop efficient therapeutics approaches. This study aimed to verify the prevalence of UP and its associated factors. Methods and Findings:Prospective and cross-sectional study with patients undergoing hemodialysis at a university public hospital. The data were obtained between April 2014 and April 2015. The statistical analysis was carried out using multivariate regression models, and statistical significance was set at p<0.05. A total of 164 patients were included, and pruritus was reported in 64 (39%). In the multivariate analysis, a higher creatinine level was risk factor for pruritus (β=1.09, 95% CI 1.00-1.19; p=0.048), as was a lower level of hemoglobin (β=0.85, 95% CI 0.73-0.99; p=0.043). Dyslipidemia (β=1.52, 95% CI 0.12-2.91; p=0.03), obesity (β=2.40, 95% CI 1.03-3.78; p=0.001), higher levels of C-reactive protein (β=0.26, 95% CI 0.19-0.34; p<0.001) and black race (β=1.49, 95% CI -2.57 and 0.42; p<0.006) were associated with a greater intensity of pruritus. The use of a high-flux dialyzer was associated with a lower intensity of pruritus (β=-1.69, 95% CI -3.05-0.34; p=0.01). Conclusion:Uremic pruritus has a high prevalence in hemodialysis patients, and the data suggest that the higher the creatinine and the lower the hemoglobin levels are, the greater the risk of developing pruritus is. Dyslipidemia, obesity, and higher levels of C-reactive protein were associated with a greater intensity of pruritus, whereas the use of a high-flux dialyzer was associated with lower pruritus intensity.

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Section: Discussionsupporting

confidence: 52%

Factors associated with uremic pruritus

et al. 2017

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“…1,22,44,45,48 Subsequent studies, however, have not confirmed these associations. 3,39 Furthermore, apart from 1 early prospective study showing a decrease in itching with increasing Kt/ V, 46 subsequent studies have not shown improvement in CKD-aP with increasing dialysis efficiency. 38,49 It is currently thought that underdialysis and toxin deposition may cause CKD-aP in a subset of patients, and that itching in this subset should resolve with achievement of Kidney Disease: Improving Global Outcomes (KDIGO) goals for Kt/V, calcium, phosphorus, and PTH.…”

Section: Toxin Depositionmentioning

confidence: 99%

CKD-Associated Pruritus: New Insights Into Diagnosis, Pathogenesis, and Management

Verduzco

Shirazian

2020

Kidney International Reports

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102

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Chronic kidney disease-associated pruritus (CKD-aP) is a common, troubling and in some cases debilitating problem for patients with CKD and end-stage renal disease. Despite a prevalence rate of approximately 20% in CKD and 40% in end-stage renal disease, and a clear association with poorer psychosocial and medical outcomes, this condition is often underreported by patients and overlooked by health care providers. This is likely due, in part, to uncertainty regarding its pathogenesis and treatment. Most commonly, CKD-aP is attributed to toxin build-up, peripheral neuropathy, immune system dysregulation, or opioid dysregulation. Prior treatment studies of CKD-aP have targeted these potential etiologies but have been limited by noncontrolled design, small sample size, and non-uniform definitions of CKD-aP. Recently, several large, randomized controlled trials targeting opioid dysregulation have yielded promising results. These trials have spurred new hope for understanding and treating this condition.

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“…Pruritus is associated with increased mortality, worsened physical/ mental wellbeing, and poor sleeping patterns. The pathogenesis of uremic pruritus remains obscure and poorly explained by currently acknowledged associations with serum calcium and phosphate levels (23). Multiple treatments are traditionally used and often fail to effectively alleviate patient symptoms.…”

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confidence: 99%