Dermatological manifestations in chronic renal failure patients with and without hemodialysis: A study at a tertiary care centre

Abstract

Background: Skin is an important diagnostic window to many diseases of internal organs including the renal system. Subtle changes in the skin may act as a clue to the underlying renal pathology. The cutaneous manifestations may be caused either by the disease or drugs used in the treatment of chronic kidney disease (CKD). Aim: The aim of this study is to investigate and compare cutaneous manifestations in patients with CKD on hemodialysiswith patients not on dialysis. Materials and Methods: One hundred patients with CKD were recruited, 50 each in maintenance hemodialysis (MHD) and nondialysis group. Detailed cutaneous examination and necessary investigations were done, and cutaneous manifestations were compared among the two groups. Results: Of the 100 patients, 72 were males and 28 were females. Mean duration of disease was 32.4 months in the dialytic group and 11.2 in the nondialytic group. The most common underlying disease that lead to CKD was diabetes mellitus. Specific cutaneous manifestations observed were Kyrles disease 4%, calcinosis cutis 1%, and uremic frost in 1%. The common nonspecific manifestations observed were xerosis in 59% (dialytic 61.03%, nondialytic 38.98%), pallor in 57% (dialytic 49.1%, nondialytic 50.9%), pruritus in 38%, (dialytic 63.16%, nondialytic 36.84%), pigmentation in 32% (dialytic, 65.63%, nondialytic 34.37%), purpura in 8% of dialytics, and none of the nondialytic patients had purpura. Cutaneous infections were found in 28%, of which fungal were 20%, bacterial 7%, and viral infections 2%. Nail changes were observed in 46% (dialytic 62%, nondialytic 30%), hair changes in 16%, and mucosal manifestations in 11% of the patients. Puncture marks were found in 74% of the dialytic patients. Xerosis, pruritus, and pigmentation had significantly higher prevalence in diabetic uremics compared to nondiabetic uremics. Conclusions: There was a significant association with the mean duration of disease, which is higher in dialytic patients compared to the nondialytic group. Xerosis, pruritus, and hyperpigmentation were common in dialytic patients.