Observations on the Association of Serum histamine, Interleukins and Other Serum Biochemical Values with Severity of Pruritus in Chronic Hemodialysis Patients

Abstract

Pruritus is one of the most bothersome symptoms in patients on maintenance hemodialysis (HD), however little progress is seen in our understanding of its pathogenesis and the association of different serum biochemical values with its severity. The aim of this study was to evaluate pruritus in HD patients in Benha hospital, Egypt, and to correlate its presence and severity with relevant clinical and laboratory parameters. Fifty Hemodialysis patients were randomly selected from a total of ninety nine patients receiving chronic hemodialysis. An elaborate survey, that included interviews, was conducted to identify patients with pruritus. Twenty one patients on maintenance HD have uremic pruritus (UP) out of fifty patients were enrolled in the study. Blood samples from hemodialysis patients and hemodialysis patients with pruritus were taken during the dialysis. Serum samples were kept frozen at - 20°C until chemical and immunoassay were performed. Some relevant clinical and laboratory parameters including Na, K, IL-2, IL-6, cortisol and histamine were evaluated. In 21 patients (42%) pruritus intensified during dialysis. There were significant increase (P<0.05) in the serum levels of BUN, Cr, IL-2, IL-6, and there was a highly significant increase in histamine and cortisol. The results of this investigation showed that several serum biochemical values (cortisol, histamine, IL-2 and IL-6) had increased significantly in uremic patients compared to hemodialysis patients, and healthy patients. The results of this investigation suggest that many factors may have important role in pathogenesis and progression of uremic pruritus from mild to severe. The association of histamine, cortisol, IL-2 and IL-6 are evident; compromised immune function and electrolytes disturbances are related to impaired kidney function and the accumulation of uremic toxins. Further research is needed to elucidate the main causes of UP, and the predictive value of serum biochemical components. The effect of the dialyzing membrane should be factored in any such investigation. The results of our study point out to the potential important role of both IL-2 and IL-6 in UP. Further studies are needed to investigate the contribution of histamine, IL-2 and IL-6, monocytes, and basophils on the development and severity of uremic pruritus, and the possible role of anti-IL-2 and IL-6 receptor antibodies in treatment of severe pruritus. Further, research using a proteomic approach to identify itching-related uremic toxins, and the biomarkers that can be used for early detection of PU is urgently needed.