Serological markers of renal itch in patients receiving long term haemodialysis

Carmichael, Andrew; McHugh, Mary M; Martin, Anthony; Farrow, Malcolm

doi:10.1136/bmj.296.6636.1575

Cited by 54 publications

(45 citation statements)

References 2 publications

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“…The role of secondary hyperparathyroidism in uremic pruritus is controversial. Our investigation, in agreement with Tarng et al [15] and Carmichael et al [2], revealed no substantial difference in serum iPTH values among our patients with or without severe pruritus. It is likely that hpyerparathyroidism is not responsible for severe pruritus in our patients.…”

Section: Discussionsupporting

confidence: 82%

“…Our data, in agreement with those of Balaskas et al [6], further support the observation that dialysis adequacy was not the single factor contributing to pruritus. The relationship between biochemical characteristics and PS is still questionable although many hypotheses have been advanced [1][2][3][4][5]. The lack of an association is supported by our failure to establish a relationship between clinical parameters and PS in our CAPD population (table 3).…”

Section: Discussionmentioning

confidence: 52%

“…Several factors have been suggested to be involved in the pathogenesis of pruritus [1][2][3], namely hypercalcemia, hyperphosphatemia, hypermagnesemia, and elevated plasma parathyroid hormone with high calcium phosphate product, albeit conflicting results remained [4,5]. To our knowledge, however, only few data concerning the pruritus in continuous ambulatory peritoneal dialysis (CAPD) patients are available [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Viral Hepatitis Infection Should Be Considered for Evaluating Uremic Pruritus in Continuous Ambulatory Peritoneal Dialysis Patients

Hung

Shyu²,

Tsai³

et al. 1998

Blood Purif

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Determining the possible association of viral hepatitis infection and degree of pruritus is the primary concern of this study. Ninety-six adequately dialyzed CAPD patients (47 male and 49 female) and 526 normal controls (266 male and 260 female) were enrolled. Blood hemoglobin, ferritin, electrolytes, calcium, phosphate, albumin, urea, creatinine, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase, and bilirubin were analyzed by routine methods. Serum HBsAg was examined, using a radioimmunoassay method and the anti-HCV, an enzyme immunoassay method. All cases were interviewed with a standardized questionnaire. The highest possible pruritus score (PS) was 22. The prevalences of HBsAg(+) and anti-HCV(+) were 14.6% and 17.7%, respectively. The mean PS in all 96 CAPD patients was 11.6 (range 7–22). The mean PS were 11.8 ± 0.6 and 12.5 ± 1.0 for patients infected with HBV and HCV, respectively. Both were significantly higher than that (10 ± 0.9) of patients without hepatitis infection. AST and ALT were significantly higher in patients infected with viral hepatitis than those without. The other biochemical parameters were not significant. Thirty-seven (38.5%) of our 96 patients had mild pruritus (PS 7) and 11 (15.9%) had severe pruritus (PS ≧15). Of the 83.9% (26/31) patients with viral hepatitis, the grades of skin itching were moderate to severe; whereas those of the patients without viral hepatitis, 53.6% (37/69) belonged to the group of moderate to severe pruritus (p = 0.003, χ² test with Yates’ correction). The authors recommended screening of viral hepatitis infection to be undertaken for uremic patients with unexplained skin itching.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Viral Hepatitis Infection Should Be Considered for Evaluating Uremic Pruritus in Continuous Ambulatory Peritoneal Dialysis Patients

Hung

Shyu²,

Tsai³

et al. 1998

Blood Purif

View full text Add to dashboard Cite

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“…In the published literature [4][5][6][7][8], these authors suggest ed that the deranged metabolism of divalent ions, i.e. hypercalcemia, hyperphosphatemia and high calciumphosphorus product, is the serological marker of renal itching in certain uremic patients.…”

Section: Discussionmentioning

confidence: 99%

Hemodialysis-Related Pruritus: A Double-Blind, Placebo-Controlled, Crossover Study of Capsaicin 0.025% Cream

Tarng¹,

Cho

Liu

et al. 1996

Nephron

121

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Pruritus is a significant symptom among patients receiving hemodialysis. However, its underlying mechanisms remain obscure. Substance P, a neuropeptide, has been implicated in the mediation of pain and some itch sensations. Local application of capsaicin depletes the peripheral neurons of substance P and may block the conduction of pain or pruritus. This study aims to assess the efficacy and safety of capsaicin 0.025% cream in the treatment of hemodialysis-related pruritus and to further explore the underlying pathomechanism. Nineteen hemodialysis patients with idiopathic, moderate (n = 5) to severe (n = 14) pruritus were examined in a double-blind, placebo-controlled, crossover study and 17 of them completed the study. Topical agent of capsaicin or placebo base cream was applied to localized areas of pruritus 4 times a day. The severity of pruritus and treatment-related side effects (cutaneous burning/stinging sensations, dryness, or erythema) were evaluated weekly. The results showed (1) that 14 of 17 patients reported marked relief and 5 of these 14 patients had complete remission of pruritus during capsaicin treatment (Wilcoxon signed-ranks test, 2p < 0.001); (2) capsaicin was significantly more effective than placebo (Mann-Whitney rank sum test, 2p < 0.001) and a prolonged antipruritic effect was observed 8 weeks posttreatment; (3) no serious side effects were noted during the study and (4) there were no significant changes in serum concentrations of albumin, calcium, phosphorus, alkaline phosphatase, or intact parathyroid hormone during the treatment with either capsaicin or placebo. In summary, the present study indicates indirectly that idiopathic pruritus in some patients on maintenance hemodialysis may be transmitted by substance P from the peripheral sensory neurons to the central nervous system. Topical capsaicin with the unique pharmacological effect is demonstrated to markedly improve the pruritus of these patients.

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“…In one recent study, 37 dialysis patients with secondary hyperparathyroidism and pruritus underwent parathyroidectomy leading to a statistically significant decrease in pruritus scores [52]. In spite of these facts, no correlation between parathormone (PTH) levels and intensity of itching was found in most of the studies [9,42,45]. PTH itself is not pruritogenic when injected into the skin [53].…”

Section: Hyperparathyroidismmentioning

confidence: 99%