Environmental NO2 and CO Exposure: Ignored Factors Associated with Uremic Pruritus in Patients Undergoing Hemodialysis.

Wen-Hung Huang,Cheng-Hao Weng,Ching-Wei Hsu,Jui-Hsiang Lin,Tzung-Hai Yen

doi:10.1038/srep31168

Abstract

Uremic pruritus (UP), also known as chronic kidney disease–associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution–induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD. We analyzed the following variables for association with UP: average previous 12-month and 24-month background concentrations for nitrogen dioxide (NO2) and carbon monoxide (CO), and suspended particulate matter of <2.5 μm (PM2.5). In a multivariate logistic regression, hemodialysis duration, serum ferritin levels, low-density lipoprotein levels, and environmental NO2/CO levels were positively associated with UP, and serum albumin levels were negatively associated with UP. This cross-sectional study showed that air pollutants such as NO2 and CO might be associated with UP in patients with MHD.

Highlights

Outdoor air pollution has well-known effects on the health of patients with allergic diseases
50.8% were male, 21.8% had Uremic pruritus (UP), 22.2% had a history of diabetes mellitus (DM), 4.7% had cardiovascular diseases (CVDs), 2.9% had lupus, 17.3% were habitual users of tobacco, 79.6% had an AV fistula that was utilized, 11.3% had hepatitis B virus infection, and 19.4% had hepatitis C virus infection. normalized protein catabolism rate (nPCR) (HCV) infection
Comparing patients with and without UP, a higher proportion of patients with UP lived in Taipei Basin (65.1% vs 6.6%, respectively; P < 0.001), had an HCV infection (24.9% vs 17.9%, respectively; P = 0.037), and had undergone HDF (27.5% vs 19.9%, respectively; P = 0.028), while a lower proportion had DM (13.2% vs 24.7%, respectively; P = 0.001) and a non-anuria condition (11.6% vs 23%; P < 0.001)

Summary

Introduction

Outdoor air pollution has well-known effects on the health of patients with allergic diseases. To our knowledge, no in-depth study on the correlation between air pollutants and UP in maintenance hemodialysis (MHD) patients has been reported The aim of this cross-sectional study was to assess the role of residential area, air pollutants, age, male sex, body mass index (BMI), smoking status, diabetes mellitus (DM), hypertension, previous cardiovascular diseases (CVDs), hepatitis B virus (HBV) infection, hepatitis C www.nature.com/scientificreports/. Virus (HCV) infection, HD duration, blood access as arterial-venous(AV) fistula, undergoing hemodialfiltration (HDF), clearance of urea (Kt/Vurea Daugirdes), normalized protein catabolism rate (nPCR), non-anuria status, hemoglobin levels, serum albumin levels, serum creatinine levels, corrected calcium levels, inorganic phosphate levels, log-transformed (log) ferritin levels, log intact parathyroid hormone levels (log iPTH), log high-sensitivity C-reactive protein (log hsCRP) levels, low-density lipoprotein (LDL) levels and triglyceride levels on UP in hemodialysis (HD) patients

Methods

Results

Conclusion