Pruritus In Hemodialysis Patients Research Articles

Efficacy and safety of difelikefalin in the treatment of hemodialysis patients with pruritus: A meta-analysis and systematic review.

The incidence of pruritus associated with hemodialysis (HD) patients can be as high as 70%, and ~40% of patients suffer from moderate to severe systemic pruritus. Difelikefalin (CR845), a peripheral restrictor κ-opioid receptor agonist, activates opioid receptors on peripheral neurons and immune cells to relieve pruritus in patients. However, the clinical effect of difelikefalin on HD-related pruritus is unclear. Therefore, the purpose of this meta-analysis and systematic review was to investigate the safety and efficacy of difelikefalin in the treatment of HD-associated pruritus. This study explored the efficacy and safety of difelikefalin in the treatment of pruritus in HD patients by systematic review and meta-analysis. Randomized controlled trials on difelikefalin in the treatment of pruritus in HD patients were retrieved from PubMed, Embase, Cochrane Library, and Web of Science electronic databases. The retrieval deadline was January 1, 2023. Stata 15.0 software was used for data analysis of the included studies. A total of 4 randomized controlled trials were included, totaling 1,268 patients (736 patients in the experimental group and 532 patients in the control group). Results of the meta-analysis showed that, compared with the control group, difelikefalin could significantly improve the Worst Itch Numeric Rating Scale score (improvement > 3; risk ratio (RR)=1.28, 95% confidence interval (CI) (1.07, 1.53)), decrease the 5-D itch score (standardized mean difference=-0.43, 95% CI (-0.55, -0.30)), and significantly improve adverse events (RR=1.33, 95% CI (1.13, 1.56)). Although difelikefalin can improve itching symptoms in HD patients, it can also increase adverse reactions based on the current literature. Therefore, more studies are needed to further explore the safety and efficacy of difelikefalin treatment.

A Systematic Review of Efficacy and Safety of Difelikefalin in Treating Pruritus in Hemodialysis Patients with Chronic Kidney Disease

<p class="TableParagraph"><strong>Background: </strong>Chronic Kidney Disease (CKD) is a type of kidney disease that gradual loss of kidney function over a period of months or years, usually more than 3 months. Uremic pruritus or chronic kidney disease-associated with CKD (CKD-aP) is a common complication that experienced by CKD patients especially for patients undergoing haemodialysis and it will negatively impact quality of life, for example depression, poor sleep quality, and miss dialysis sessions.</p><p class="TableParagraph"><strong>Methods: </strong>Three online databases were used for the literature search: Science Direct, Embase, and PubMed. obtaining the information in January 2024. Using specific keywords, a comprehensive analysis of research articles was carried out. We examined the safety and effectiveness of difelikefalin in the management of pruritus in patients receiving hemodialysis who have chronic kidney disease.</p><p class="TableParagraph"><strong>Result: </strong>Six studies were evaluated that met the criteria for inclusion. The efficacy of difelikefalin in all studies was examined by using WI-NRS as assessment tools for the primary outcome, and for the secondary outcome, skindex-10 or skindex-16 scoring, the 5-D itch scale, and the itch MOS (Medical Outcome Study) sleep disturbance scale were used. From all studies, difelikefalin in various dosages and routes (oral and intravenous) improved pruritus reduction in hemodialysis patients with CKD over placebo. However, in the majority of cases, difelikefalin caused a higher chance of experiencing adverse events than in the placebo group.</p><p class="TableParagraph"><strong>Conclusions: </strong>All studies show a greater pruritus reduction in hemodialysis patients receiving therapy over placebo, with the optimal benefit-risk at 0.5 μg/kg of difelikefalin, despite unclear efficacy-dosage connections.</p>

The Effects of Auricular Acupressure on Pruritus, Skin Dryness, and Depression in Hemodialysis Patients

Purpose: This study investigated the effects of auricular acupressure therapy on pruritus, skin dryness, and depression in hemodialysis patients.Methods: This was a randomized control group pre-post experimental study. Fifty-four patients undergoing maintenance hemodialysis at a single center voluntarily participated in the study. Twenty-seven participants were randomly assigned to the experimental group, to whom auricular acupressure was applied to five designated acupoints (shenmen, heart, kidney, lung, and occiput) for 5 weeks. The control group (n=27) received no intervention for the first 5 weeks, and the auricular acupressure intervention was administered due to ethical considerations after 5 weeks. Pruritus, pruritus-related sleep disturbance, and depression were scored accordingly. Skin dryness was assessed by measuring transepidermal water loss (TEWL) and stratum corneum hydration (SCH) levels.Results: Auricular acupressure therapy significantly reduced pruritus (z=-3.97, <i>p</i><.001) and pruritus-related sleep disturbance (z=-2.97, <i>p</i>=.003) in the experimental group. TEWL showed a significant reduction in the arm (z=-2.23, <i>p</i>=.026) and body (z=-1.97, <i>p</i>=.049) but not in the leg. There were no differences in SCH levels and depression (z=-0.35, <i>p</i>=.721).Conclusion: Auricular acupressure therapy effectively alleviated pruritus and skin dryness. This study confirmed the safety and effectiveness of auricular acupressure therapy as a viable intervention for pruritus in hemodialysis patients.

AST-120 improved uremic pruritus by lowering indoxyl sulfate and inflammatory cytokines in hemodialysis patients.

Pruritus is a common and distressing symptom that affects patients with chronic kidney disease. The concentration of protein bounded uremic toxin was associated with the uremic pruritus. The aim is to assess the efficacy of AST-120 for uremic pruritus in hemodialysis patients. The participants were enrolled and then divided into the AST-120 treatment group and control group with a ratio of 2:1. All participants underwent pre-observation screenings two weeks before the study with three visits. In the treatment phase (week 1 to week 4), the treatment group added 6g/day of AST-120 along with routine anti-pruritic treatment. Visual analog scale (VAS) and biochemical parameters were measured. The VAS score began to be lower in the AST-120 treatment group after the 5th visiting (p < 0.05). The reduction in indoxyl sulfate (IS) at 5th week along with TNF-alpha. The reduction ratio of indoxyl sulfate correlated with reduction of parathyroid hormone. This study has demonstrated that the four-week treatment of AST-120 decreased the severity of uremic pruritus in patients with ESRD. The concentration of IS and TNF-alpha decreased in the AST-120 treatment group. The reduction of iPTH correlated with the reduction of IS in the AST-120 treatment.

Effect of Dill (Anethum graveolens) Oil on Pruritus and Quality of Life of Hemodialysis Patients: A Randomized Double-Blind Three-Arm Controlled Trial.

Anethum graveolens (AG), commonly known as dill, is a plant from the Apiaceae family that has been traditionally used as a skin softener and purifying agent in Persian medicine. In a previous study conducted on male rats, dill was found to have anti-inflammatory effects. The current study aimed to examine the efficacy of topical application of Anethum graveolens oil on pruritus severity, skin dryness, sleep quality, and quality of life in patients undergoing hemodialysis. In the current clinical trial, the participants were randomly assigned to one of these groups: topical AG preparation, sesame oil, or a control group receiving no treatment. The study was double-blind and placebo-controlled. The topical treatment was applied twice a day for one month to areas of the skin affected by pruritus. The outcome measures included the severity of skin dryness, the Pittsburgh Sleep Quality Index, Duo's Uremic Pruritus Severity Scale, and the Itchy QoL questionnaire. This study involved 106 hemodialysis patients, and after intervention for one month, the medication group had a significantly lower mean score of sleep quality (3.24 ± 2.41) than the placebo (4.54 ± 3.11) and control (5.05 ± 3.21) groups (P=0.032). The mean change in pruritus severity was significantly greater in the medication group (-17.28 ± 8.938) than the placebo (-5.91 ± 5.398) and control (-3.43 ± 3.228) groups (P < 0.001). Moreover, a significant difference was observed in the mean changes in quality of life between the medication, placebo, and control groups, with values of -14.88 ± 7.89, -5.34 ± 4.50, and -1.92 ± 2.86, respectively (P < 0.001). Furthermore, both the medication and placebo groups showed improvement in skin dryness compared to the control group having the values of -1.65 ± 0.91, -1.11 ± 0.79, and -0.38 ± 0.54, respectively (P < 0.001). Topical Anethum graveolens preparation significantly improved the sleep quality and quality of life and reduced skin pruritus and dryness in hemodialysis patients. It could be considered as a simple therapeutic modality to control pruritus in hemodialysis patients. This trial is registered with IRCT2017022032671N1.

Difelikefalin for Hemodialysis Patients with Pruritus in Japan

BackgroundDifelikefalin, a peripherally specific selective agonist of kappa opioid receptors, has been approved for the treatment of pruritus in hemodialysis patients in the United States. However, there is limited evidence for postdialysis intravenous use in non-U.S. populations.MethodsIn this double-blind, placebo-controlled, phase 3 trial in Japan, patients with moderate to severe pruritus were randomly allocated 1:1 to receive either placebo or 0.5 μg/kg of difelikefalin three times per week intravenously for 6 weeks. The primary end point was change from baseline in the Worst Itching Intensity Numerical Rating Scale (NRS; 0 to 10; higher scores indicate more severe itching) score at week 4.ResultsA total of 230 patients were screened, of whom 178 were randomly assigned to receive placebo (n=89) or difelikefalin (n=89). The change from baseline in the weekly adjusted mean NRS score (95% confidence interval) at week 4 in the placebo and difelikefalin groups was −1.09 (−1.47 to −0.70) and −2.06 (−2.45 to −1.66), respectively. The difference between the groups was −0.97 (−1.52 to −0.42), demonstrating that difelikefalin was superior to placebo (P<0.001). Prespecified secondary quality-of-life end points showed consistent improvement associated with difelikefalin. The incidence of treatment-related adverse events in the placebo and difelikefalin groups was 3 of 89 patients (3%) and 13 of 89 patients (15%), respectively, of which the majority in the difelikefalin group were gastrointestinal (e.g., constipation and abdominal discomfort).ConclusionsIntravenous difelikefalin reduced itching and improved quality of life in patients with moderate to severe pruritus who were undergoing maintenance hemodialysis. (Funded by Kissei Pharmaceutical Co., Ltd.; ClinicalTrials.gov number, NCT04711603.)

FREQUENCY OF CHRONIC KIDNEY DISEASE ASSOCIATED PRURITUS AND ITS ASSOCIATION WITH SLEEP QUALITY IN HEMODIALYSIS PATIENTS

A cross-sectional study was conducted at the Department of Medicine, Khyber Teaching Hospital Peshawar, between November 2022 and April 2023. The study aimed to evaluate the frequency of pruritus associated with chronic kidney disease (CKD) and its correlation with sleep quality in hemodialysis patients. The study cohort comprised 55 individuals diagnosed with CKD, aged between 18 and 70, and of both genders. Chi-square and Independent Samples T-tests were used for statistical analysis, and a significance level of P &lt; 0.05 was considered statistically significant. The study found that 39 (70.9%) patients reported chronic kidney disease-associated pruritus. Among the pruritus patients, 7.7% reported no effect on their sleep, 43.6% reported occasional sleep, and 48.7% reported severe effects on sleep. The study showed a significant association between increasing age and pruritus (P = 0.0001) but no significant association between pruritus and gender (P = 0.23). The mean age of the patients was 40.8±14.12 years. The study concluded that the prevalence of pruritus in hemodialysis patients with chronic kidney disease was very high. Also, pruritus in individuals with chronic renal disease significantly correlated with sleep quality and advancing age among hemodialysis patients.

Evaluation of the Effect of Gabapentin in the Management of Uremic Pruritus in Hemodialysis Patients

Background: Gabapentin is an antiepileptic agent that has analgesic properties in neuropathic pain. Given that few studies have assessed the effect of the low dose of gabapentin on uremic pruritus, this study aimed to evaluate the effect of gabapentin on pruritus of hemodialysis patients.&#x0D; Materials and Methods: This clinical trial study was conducted on dialysis patients who were referred to Shafa Hospital, Kerman. In this regard, 40 patients consumed 100 mg of gabapentin for one week. Then patients did not take any medication within the washout period and consumed a 100 mg placebo for one week. Assessment of pruritus severity was done by visual analog scale (VAS). Hematocrit, calcium, phosphor, creatinine, and albumin were evaluated. These measurements were done before and after treatments with placebo and gabapentin.&#x0D; Results: The main places of pruritus location in dialysis patients were the back (90 %), abdomen (80%), shoulder (80%), and head (70%). The mean pruritus severity before treatment, and after treatment with placebo and gabapentin, was 8.3± 1.5, 6.73 ± 1.17, and 4.58 ± 1.50, respectively. Significant difference was seen before and after treatment, in terms of pruritus severity (p&lt;0.1). In addition, there was a significant difference between gabapentin and placebo groups, regarding the severity of pruritus (p&lt;0.1). No significant difference was seen before and after treatment, regarding biochemical parameters (p&gt;0.05).&#x0D; Conclusion: According to the findings, it seems that gabapentin can be an effective and safe treatment for pruritus in patients on hemodialysis. The therapeutic approach chosen for these patients is based on the neuropathic hypothesis.

Pruritus in Hemodialysis Patients: Longitudinal Associations With Clinical and Patient-Reported Outcomes

Cross-sectional studies have reported an association of chronic kidney disease-associated pruritus (CKD-aP) with adverse clinical events and patient-reported outcomes (PROs). We studied the longitudinal associations between changes in CKD-aP and clinical outcomes among patients receiving maintenance hemodialysis. Prospective cohort study. 7,976 hemodialysis recipients across 21 countries in phases 4-6 (2009-2018) of the Dialysis Outcomes and Practice Patterns Study (DOPPS) who had 2 CKD-aP assessments approximately 12 months apart. Exposure status was based on the assessment of pruritis initially and again approximately 1 year later. Four groups were identified, including those with moderate or more severe pruritis only at the initial assessment (resolved), only at the second assessment (incident), at neither assessment (absent), or at both assessments (persistent). Laboratory values and PROs ascertained at the initial assessment of pruritis and 1 year later. Linear mixed model to investigate changes in laboratory values and PROs over the 1-year study period across the 4 exposure groups. 51% of patients had moderate to severe CKD-aP symptoms at either assessment (22% at both). The prevalences of depression, restless sleep, and feeling drained increased over the study period (+13%,+10%, and+14%, respectively) among patients with incident pruritus and decreased (-5%,-8%, and-12%, respectively) among patients with resolved pruritus. Minimal changes in PROs over time were observed for the absent and persistent groups. Changes over time in laboratory values (phosphorus, Kt/V) were not detected for either of these groups. Compared with patients with absent CKD-aP, the adjusted HRs for patients with persistent CKD-aP were 1.29 (95% CI, 1.09-1.53) for all-cause mortality, 1.17 (1.07-1.28) for all-cause hospitalization, and 1.48 (1.26-1.74) for cardiovascular events. No interim evaluation of CKD-aP symptoms between the 2 assessments; potential selection bias from patients who died or were otherwise lost to follow-up before the second assessment. CKD-aP symptoms are chronic, and these findings highlight the potential value of repeated assessment of this symptom using standardized approaches. Future research should systematically investigate potential causes of CKD-aP and options for its effective treatment. Previous research has studied itching and its consequences in hemodialysis recipients only at a single time point. We surveyed 7,976 patients receiving maintenance hemodialysis to assess itching over a period of 1 year. We found that, among those experiencing itching at the initial assessment, more than half had persistent symptoms 1 year later. Those in whom itching developed during follow-up were more likely to experience depression, poor sleep, long recovery times after dialysis, and feeling faint or drained. These patients also rated their quality of life as poorer than those who did not experience itching. These findings emphasize the potential value of clinical detection of itching and the pursuit of effective treatments for patients receiving dialysis experiencing these symptoms.

Efficacy of polymethylmethacrylate membrane hemodiafilter Filtryzer® PMF™-21A in improving pruritus in hemodialysis patients: a prospective interventional study

BackgroundHemodialysis-associated pruritus (HAP) occurs in 60–80% of hemodialysis patients. This significant complication not only decreases quality of life through sleep disturbance and depression, but also leads to poor survival outcomes. The polymethylmethacrylate (PMMA) membrane was the first synthetic polymer membrane for the hollow-fiber artificial kidney created in 1977. PMMA membrane dialyzers have been reported to be effective for improving various complaints, including pruritus, and nutritional status. In Japan, a PMMA membrane hemodiafilter Filtryzer® PMF™-A (PMF-A) was launched in November 2021 and subsequently became available for online hemodiafiltration (OHDF). This study aimed to determine whether PMF-A effectively improves pruritus in hemodialysis patients.MethodsParticipants were 20 patients (median age 74.5 years) on predilution OHDF (pre-OHDF) or postdilution OHDF (post-OHDF) using an Asymmetric Triacetate Membrane® hemodiafilter (FIX-210E eco or FIX-210S eco), who were experiencing pruritus of “very mild” or higher severity based on the Shiratori severity score either during the daytime or nighttime. After switching to post-OHDF with PMF-21A (substitution flow rate: 10 L/session), the substitution flow rate was gradually increased according to results of pruritus evaluation every 2 weeks over 3 months. The primary endpoint was the severity of pruritus evaluated using visual analogue scale (VAS) and the Shiratori severity score. Secondary endpoints included white blood cell count (WBC), hemoglobin level (Hb), platelet count (Plt), serum albumin level (Alb), high-sensitivity C-reactive protein (hsCRP), IL-6, dry weight (DW), and solute removal performance.ResultsThe median VAS score was significantly decreased 2 weeks after switching compared with baseline (44 mm) and remained significantly decreased at Week 12 (22 mm; p < 0.01). From baseline to Week 12, 16 patients (80%) showed improvement in VAS score. The percentage of patients with mild to moderate daytime pruritus according to the Shiratori severity score decreased significantly from 80.0% to 45.0% (p < 0.05), whereas no significant change was observed for nighttime pruritus (p = 0.267). Pre-dialysis serum β2-MG levels were significantly higher at Week 12 compared with baseline. No significant changes were observed in WBC, Hb, Plt, serum Alb, hsCRP, IL-6, or DW.ConclusionsOHDF with PMF-21A may be more effective in improving HAP.

Prevalence, patient burden and physicians' perception of pruritus in haemodialysis patients.

Chronic kidney disease-associated pruritus (CKD-aP) is an underrated symptom in patients with impaired kidney function. The present study assessed the prevalence, impact on quality of life (QoL) and risk factors for CKD-aP in a contemporary national cohort of patients on haemodialysis. In addition, we evaluated attending physicians' awareness and approach to therapy. Validated patient's and physician's questionnaires on pruritus severity and QoL were used in combination with information obtained by the Austrian Dialysis and Transplant Registry. The prevalence of mild, moderate and severe pruritus in 962 observed patients was 34.4%, 11.4% and 4.3%. Physicians' estimated prevalence values were 25.0 (95% CI 16.8-33.2), 14.4 (11.3-17.6) and 6.3% (4.9-8.3), respectively. The estimated national prevalence estimate extrapolated from the observed patients was 45.0% (95% CI 39.5-51.2) for any, 13.9% (95% CI 10.6-17.2) for moderate and 4.2% (95% CI 2.1-6.2) for severe CKD-aP. CKD-aP severity was significantly associated with impaired QoL. Risk factors for moderate-severe pruritus were higher C-reactive protein [odds ratio (OR) 1.61 (95% CI 1.07-2.43)] and parathyroid hormone (PTH) values [OR 1.50 (95% CI 1.00-2.27)]. Therapy for CKD-aP included changes in the dialysis regimen, topical treatments, antihistamines, gabapentin and pregabalin and phototherapy in a majority of centres. While the overall prevalence of CKD-aP in our study is similar to that in previously published literature, the prevalence of moderate-severe pruritus is lower. CKD-aP was associated with reduced QoL and elevated markers of inflammation and PTH. The high awareness of CKD-aP in Austrian nephrologists may explain the lower prevalence of more severe pruritus.

The effectiveness of sertraline in alleviating uremic pruritus in hemodialysis patients: a randomized clinical trial

IntroductionUremic pruritus (UP) is a common and distressing symptom in end stage renal disease (ESRD) patients. Many approaches have been tested to improve UP without a clear success. We aimed to assess the effect of sertraline on UP in hemodialysis (HD) patients.MethodsThis research is a double-blinded, placebo-controlled, multicentric randomized clinical trial which included sixty patients maintained on regular HD. Patients were allocated to receive sertraline 50 mg twice daily or placebo for 8 weeks. The Visual analogue scale (VAS) and the 5-D itch scale were used to assess pruritus before and after the course of treatment.ResultsAt study end in sertraline group, there was a significant decrease from baseline findings in the VAS score (p < 0.001), and the 5-D itch scale (p < 0.001). On the other hand, in placebo group the VAS score showed a slight non-significant decrease (p = 0.469), and the 5-D scale (p = 0.584) increased from baseline measurements. The percentage of patients with severe and very severe pruritus decreased significantly in the sertraline group in both scores [(VAS score: p = 0.004), (5-D itch score: p = 0.002)] with no significant change in the placebo group [(VAS score: p = 0.739), (5-D itch scale: p = 0.763)]. There was a significant positive relation between the VAS and 5-D itch scores and serum urea with p value of 0.002 and 0.001 respectively, and serum ferritin with p value of < 0.001 with both.ConclusionsPatients treated with sertraline had a significant improvement in pruritus as compared with those who received placebo suggesting a potential role for sertraline to treat uremic pruritus in HD patients. Larger randomized clinical trials are needed to confirm these findings.Trial registrationClinicalTrials.gov NCT05341843. First registration date: 22/04/2022.

A phase IV, randomised, double-blind, controlled, parallel group trial to evaluate the effectiveness and safety of Balneum Plus versus emollient in the treatment of chronic kidney disease-associated pruritus in haemodialysis patients.

Chronic kidney disease-associated pruritus (CKD-aP) is a common, distressing complaint in patients with advanced renal disease that is frequently overlooked. Treatment is often unsatisfactory. Balneum Plus (Almirall, Barcelona, Spain) is a cream containing 3% lauromacrogols and 5% urea, commonly used to treat atopic dermatitis. It has not been studied in CKD-aP to date. Adult haemodialysis patients were randomised 1:1 to apply Balneum Plus or E45 (Reckitt Beckiser, Slough, UK) to compare the active ingredients of lauromacrogol and urea with a control cream. Itch was defined as three episodes of itching during the last 2weeks, appearing a few times a day, lasting a few minutes and troubling the patient [1]. Patients with other causes of itch, e.g. eczema and liver disease, were excluded. The primary outcome was a reduction in itch as measured by the visual analogue scale (VAS) score at 4weeks and analysed using an analysis of covariance approach. A total of 314 patients were screened and 58 patients were randomised, 29 in each group. Three patients dropped out in each group. The median baseline VAS scores were 6.5 [interquartile range (IQR) 4.4-8.0] in the Balneum Plus group and 6.3 (IQR 5.1-7.3) in the E45 group. After 4weeks, VAS scores decreased to 2.6 (IQR 0.9-4.5) and 2.0 (IQR 0.5-4.8) in the Balneum Plus and E45 groups respectively (P=0.64 for the difference). Using a validated questionnaire to assess secondary outcomes, we found that the Balneum Plus group had longer itching episodes, more difficulty staying asleep and itching was more annoying than in the E45 group. There was no significant difference in adverse events between the two groups. One patient reported inflamed spots on the abdominal skin in the Balneum Plus group. This is the first randomised controlled study of two different emollients for the treatment of CKD-aP and is a negative study. We found no significant difference in itch scores between Balneum Plus and E45.

Randomized controlled trial of nalfurafine for refractory pruritus in hemodialysis patients

Background Chronic kidney disease-associated pruritus (CKD-aP) is very common and sometimes refractory to treatment in hemodialysis patients. In a trial conducted in Japan, nalfurafine, effectively reduced itching of treatment-resistant CKD-aP. Our present bridging study aimed to evaluate the efficacy and safety of nalfurafine in Chinese cohort with refractory CKD-aP. Methods In this phase III, multicenter bridging study conducted at 22 sites in China, 141 Chinese cases with refractory CKD-aP were randomly (2:2:1) assigned to receive 5 μg, 2.5 μg of nalfurafine or a placebo orally for 14 days in a double-blind manner. The primary end point was the mean decrease in the mean visual analogue scale (VAS) from baseline. Results A total of 141 patients were included. The primary endpoint analysis based on full analysis set (FAS), the difference of mean VAS decrease between 5 μg nalfurafine and placebo group was 11.37 mm (p = .041); the difference of mean VAS decrease between 2.5 μg and placebo group was 8.81 mm (p = .110). Both differences were greater than 4.13 mm, which met its predefined success criterion of at least 50% efficacy of the key Japanese clinical trial. The per protocol set (PPS) analysis got similar results. The incidence of adverse drug reactions (ADRs) was 49.1% in 5μg, 38.6% in 2.5 μg and 33.3% in placebo group. The most common ADR was insomnia, seen in 21 of the 114 nalfurafine patients. Conclusions Oral nalfurafine effectively reduced itching with few significant ADRs in Chinese hemodialysis patients with refractory pruritus.

Effectiveness of self-acupressure interactive modules as a learning resource in reducing pruritus in hemodialysis patients

Introduction: The prevalence of pruritus in hemodialysis patients is relatively high due to the impact of chronic renal failure. Numerous studies have examined uremic pruritus and acupressure. Patients can learn self-acupressure to relieve pruritus by using an interactive module. Objective: To determine the effectiveness of the self-acupressure interactive module as a learning source in relieving pruritus.

Is Acupressure Effective To Treat Pruritus In Hemodialysis Patients? A Literatur Review

Aims: Chronic kidney diseases effects make the pruritus prevalence in hemodialysis patients relatively high. Several studies have been conducted to determine the effect of acupressure on complaints of uremic pruritus. However, it is still debatable how acupressure relief pruritus complains regarding the duration of acupressure. This study aims to identify the effectiveness of acupressure against pruritus based on previous studies. Materials and Methods: An electronic literature search was conducted to identify studies that matched the inclusion criteria. The electronic databases used in this research are Wiley online library, Clinical key, ProQuest, EBSCO, and Google Scholar. The keyword used was “acupressure”, “pruritus”, “itch”, and “hemodialysis”. Results: We found 1,983 articles based on keywords, and five articles met the inclusion criteria after conducting the article selection process. Three of the four experimental studies measured pruritus using a visual analog scale, and one used a numerical scale. One study applied auricular acupressure, and four studies used acupressure. Four studies have shown that acupressure effectively reduces the scale of pruritus. One study showed no significant difference between acupressure, sham control, and negative control groups in two weeks of intervention in the severity of pruritus (p=0.66). Conclusion: Acupressure is effective in treating uremic pruritus and nurse can applied acupressure as a non-pharmacological intervention for pruritus in hemodialysis patients.

Prevalence and determinants of severity of uremic pruritus in hemodialysis patients: a multicentric study

Uremic pruritus (UP) is a common and distressing symptom in patients with advanced or end-stage renal disease under hemodialysis (HD). The present multicentric study aimed to identify prevalence and determinants...

OAT Lotion Reduces Itching Sensation Due to Pruritus in Hemodialysis Patients

Background: Hemodialysis is the most commonly used renal replacement therapy for chronic kidney disease. Symptoms caused if the patient has chronic kidney failure include uremia. Uremic pruritus is an uncomfortable condition for the patient, so it requires medication or treatment to help relieve it. Pruritus that occurs in hemodialysis patients causes itching and dryness of the skin. Objectives: The purpose of this study was to determine the effect of giving oat lotion on itching sensation in hemodialysis patients who experienced pruritus at the RS UMMI Bogor in 2020. Methods: This study used a quantitative method with a pre-experimental design and a one-group pre/post-test design. The sample selection used purposive sampling with a total of 20 respondents. The therapeutic action given is oat lotion which is applied to the part of the body that has uremic pruritus. Given 2 times a day (about 5 ml) for 7 days. The bivariate test used the Wilcoxon test. Results: the results showed that there was an effect of oat lotion on the itching sensation of hemodialysis patients who experienced pruritus, as evidenced by a decrease in the mean pre-test from 26.10 to 12.85 post-test with a p-value = 0.000. Conclusion: The itching sensation in pruritic patients undergoing hemodialysis will decrease by being given oat lotion.

Frequency and Severity of Pruritus and Its Related Factors among Patients under Hemodialysis at Ali Ibn Abitaleb Hospital in Zahedan

Background: End stage renal disease (ESRD) due to the inability of the kidneys to excrete toxins is clearly associated with many physical complications, such as skin disorders, itching and etc. The severity of pruritus varies and has varied in different societies. Considering the different statistics observed in various researches on the high prevalence of pruritus in hemodialysis patients and its adverse effects on their health, we intend to investigate the prevalence of uremic pruritus and its related factors in patients under hemodialysis at Ali Ibn Abi Talib Hospitalin Zahedan in 2019.&#x0D; Methods: A descriptive cross-sectional study was performed on 100 patients who underwent dialysis in Ali Ibn Abitaleb Hospital in 1398. Tools used for data collection was a questionnaire for demographic details and Jusipovich questionnaire. Laboratory information from patient records were entered in the information form.&#x0D; Results: The mean age of patients was 46.17 years. 56% of patients were female and 44% were male. 46% of patients had pruritus, of which 50% (23 cases) had mild pruritus, 28.26% (13 cases) moderate and 21.7% (10 cases) had severe pruritus. The average age of patients with mild pruritus was 45 years (31-67 years), in patients with moderate pruritus was 51 years (range 26 to 66 years) and in patients with severe pruritus was 49.5 (27-67years).&#x0D; Conclusion: In the present study, none of the factors such as dialysis adequacy, sex, serum phosphorus level, calcium, number of dialysis sessions, age, parathyroid hormone were significantly associated with the severity of pruritus in hemodialysis patients.

Efficacy of Difelikefalin for the Treatment of Moderate to Severe Pruritus in Hemodialysis Patients: Pooled Analysis of KALM-1 and KALM-2 Phase 3 Studies

Rationale & ObjectiveChronic kidney disease–associated pruritus (CKD-aP) in patients treated by hemodialysis (HD) impairs quality of life (QoL). Difelikefalin, a selective κ-opioid receptor agonist, decreased the intensity of CKD-aP in patients undergoing HD. This pooled analysis evaluated difelikefalin’s efficacy and the itch-related QoL overall and in subgroups defined by demographics or disease characteristics.Study DesignIn KALM-1 and KALM-2, participants were randomized (1:1) to receive intravenous difelikefalin or placebo 3 times/wk for 12 weeks, followed by a 52-week open-label extension.Setting & ParticipantsAdults with moderate to severe CKD-aP treated by HD in North America, Europe, and the Asia-Pacific region.InterventionIntravenous difelikefalin at 0.5 mcg/kg or placebo.OutcomesItch intensity (Worst Itching Intensity Numerical Rating Scale [WI-NRS]) and itch-related QoL (Skindex-10 and 5-D Itch questionnaires).Results851 participants were randomized (difelikefalin, n = 426; placebo, n = 425). This pooled analysis demonstrated early (week 1), sustained difelikefalin efficacy, with significantly greater achievement of ≥3-point WI-NRS reduction with difelikefalin (51.1%) versus placebo (35.2%; P < 0.001). Achievement of a ≥4-point WI-NRS reduction was significantly greater with difelikefalin (38.7%) versus placebo (23.4%; P < 0.001). Difelikefalin reduced itch intensity in subgroups based on age, sex, anti-itch medication use, the presence of specific medical conditions, and gabapentin or pregabalin use. More participants receiving difelikefalin versus placebo achieved clinically meaningful decreases of ≥15 points on the Skindex-10 scale (55.5% vs 40.5%, respectively; P < 0.001) and ≥5 points on the 5-D Itch scale (52.1% vs 42.3%, respectively; P = 0.01), with sustained 5-D Itch effects up to 64 weeks.LimitationsSubgroup samples were small. The WI-NRS, Skindex-10, and 5-D Itch are not used in routine clinical care of dialysis patients; therefore, findings may not reflect the real-world effectiveness of difelikefalin.ConclusionsDifelikefalin demonstrated rapid, sustained efficacy, with consistent results in diverse populations of patients treated by HD.FundingCara Therapeutics, Inc.Trial RegistrationThe KALM-1 trial is registered as NCT03422653 and the KALM-2 trial is registered as NCT03636269.