Pruritus in Dialysis Patients Treated with Parenteral Lidocaine

Tapia, Luis; Cheigh, Jhoong S.; David, David S.; Sullivan, John; Saal, Stuart D.; Reidenberg, Marcus M.; Stenzel, Kurt H.; Rubin, Albert L.

doi:10.1056/nejm197702032960508

Cited by 74 publications

(25 citation statements)

References 4 publications

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“…16,28 Additionally, as uremia progresses, peripheral nervous system becomes more affected, especially the sensory parts. 21 On the other hand, reports showing the efficacy of lidocaine, 29 capsaicin, [30][31][32] and gabapentin 33,34 in controlling UP are in favor of a relationship between neuropathy and pruritus in HD patients. Thus, we can only hypothesize that even in nondiabetic patients, disturbed glucose metabolism as demonstrated by higher HbA1c levels, at least by inducing permissive role for the development of neuropathy, may result in increased sensation of itching.…”

Section: Discussionmentioning

confidence: 99%

HbA1c Is Related with Uremic Pruritus in Diabetic and Nondiabetic Hemodialysis Patients

Afsar

Afşar

2011

Renal Failure

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Objective: Uremic pruritus (UP) remains a frequent problem in hemodialysis (HD) patients and is related to mortality. Poor glycemic control, as evaluated by hemoglobin A1c (HbA1c), is also associated with morbidity and mortality in HD patients. In this study, we investigated the relationship between UP and HbA1c in HD patients. Methods: Sociodemographic, clinical, and laboratory variables, depressive symptoms, and health-related quality of life were assessed. Severity of UP was evaluated by visual analogue scale (VAS). The scale consisted of a 10 cm horizontal line marked from 0 (denoting no itch) to 10 (denoting worst possible imaginable itch). Results: Totally, 75 patients (male/female, 41/34; diabetic/nondiabetic, 29/46; age, 51.9 ± 13.5 years) were included. The VAS pruritus score was higher in diabetic patients compared with nondiabetic patients (4.7 ± 2.8 vs. 3.0 ± 1.0, p : 0.015). In diabetics, VAS pruritus score was independently related with calcium-phosphorus product (b : +0.637, p < 0

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Section: Discussionmentioning

confidence: 99%

HbA1c Is Related with Uremic Pruritus in Diabetic and Nondiabetic Hemodialysis Patients

Afsar

Afşar

2011

Renal Failure

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“…Patients with ESRF, especially those maintained on HD, suffer from several cutaneous manifestations [5,8,11,12,16]. Persistent pruri tus is a symptom which the patient can usually hardly tolerate, and is so intense that the use of antipruritics often fails to afford sufficient relief [6,7,13,16], Some authors pointed out that the mast cell prolifera tion in various organs might induce pruritus [8], diarrhea and constipation, and bone marrow damage from a re lease of histamine [1,2,10]. In the present series, numer ous mast cells were seen in the subepidermal pericapillary areas of the patients maintained on HD, with the numberof mast cells surpassing that in nondialysis ESRF patients or in reported cases of nonspecific dermatitis with pruritus [8], The mast cell proliferation did not necessarily coincide with the presence of pruritus in the present study.…”

Section: Discussionmentioning

confidence: 99%

Microangiopathic Changes of Subepidermal Capillaries in End-Stage Renal Failure

Ichimaru¹,

Horie

1987

Nephron

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Skin biopsies were taken from 63 patients with end-stage renal failure (ESRF) and 5 normal volunteers, 53 of whom were on maintenance hemodialysis (HD) and the other 10 without HD. They were examined with light and electron microscopy and subepidermal capillaries were subjected to image analysis. Thickening of the basement membrane (BM) with multilamination of the basal lamina, endothelial activation and chronic inflammatory cell infiltration with participation of mast cells were evident. The extent of these BM changes was correlated with the duration of HD, but not significantly correlated with the clinical findings indicative of arteriosclerosis. There was significant correlation between the duration of HD and mast cell proliferation or eosinophilia. We suspect that the subepidermal capillary changes represent an inflammatory reaction provoked by uremic toxins or by the repeated use of an artificial organ.

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“…Two thirds of the patients in this double-blind study claimed total relief. Relief persisted for a day or slightly longer [94].…”

Section: Lidocainementioning

confidence: 96%