Vegetarian diet may ameliorate uremic pruritus in hemodialysis patients

Chun-Yang Tseng,Tai-Te Wu,Chia-Wen Lai,Hsuan-Jen Lin,Che-Yi Chou,Chiz-Tzung Chang,Hung-Chih Chen

doi:10.1080/0886022x.2018.1512871

Abstract

Objectives: Systemic inflammation has been reported to be associated with uremic pruritus (UP). Although a vegetarian diet can reduce systemic inflammation in hemodialysis patients, the effect of vegetarian diet on UP is not clear. The purpose of the study was to know the possible effects of vegetarian diet on UP.Methods: A cross-sectional study was done to compare the severity of UP and blood levels of systemic inflammatory markers between vegetarian and non-vegetarian hemodialysis patients. Six non-vegetarian patients with uremic pruritus changed their non-vegetarian diet to vegetarian diet for 2 months. Visual Analogue Scale (VAS) and pruritus score (PS) were used to measure the UP severity. The serum high-sensitivity C-reactive protein (hs-CRP), and interleukin-2 (IL-2) were used as markers of inflammation.Results: Both the median VAS scores (p = .043) and the median PS scores (p < .001) were lower in the Vegetarian than in the non-vegetarian group. The median values of hs-CRP in Vegetarian were lower than that for the non-vegetarian (p = .020). The median value of IL-2 was also lower in Vegetarian than that of the non-vegetarian (p = .016). There were 6 non-vegetarian patients shift to vegetarian for 2 months. The pruritus score improved and IL-2 level decreased after change to vegetarian diet.Conclusion: We concluded that vegetarian diet might be associated with the amelioration of the uremic pruritus severity in hemodialysis patients.

Highlights

Pruritus is a common and bothersome symptom among end-stage renal disease (ESRD) patients under hemodialysis (HD) treatment
We have previously reported that High sensitivity C-reactive protein (hs-CRP) was lower in uremic vegetarians on hemodialysis therapy than that of the uremic non-vegetarians on hemodialysis [8]
uremic pruritus (UP) was evaluated by the subjective VAS (Visual Analogue Scale), and the pruritus score (PS) by different hemodialysis nurses as we previously described but with a minor modification [3,4,5]

Summary

Introduction

Pruritus is a common and bothersome symptom among end-stage renal disease (ESRD) patients under hemodialysis (HD) treatment. While previous studies have shown that uremic pruritus (UP) can be present in up to 40% of hemodialysis patients [1], the pathophysiology of UP is incompletely understood. Metabolic factors, especially uremic hyperparathyroidism, iron deficiency anemia, neuropathy, medication, and skin xerosis have long been known as risk factors of UP [2,3,4]. Uremic pruritus has been known to a systemic disorder associated with inflammation. High sensitivity C-reactive protein (hs-CRP) for example, is an inflammatory marker and has been associated with UP both in hemodialysis and peritoneal dialysis patients [5,6]. Serum interleukin 2 (IL-2), has been found to be elevated in hemodialysis patients with UP [7]

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Conclusion