Uremic Pruritus In Hemodialysis Patients Research Articles

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.

Relationship between Subclinical Hypothyroidism and Uremic Pruritis in Hemodialysis Patients.

Uremic pruritus (UP) is one of the most distressing symptoms in hemodialysis (HD) patients. Subclinical hypothyroidism (SCH) is a biochemical condition with high prevalence in HD patients. The present multicentric study aimed to assess the relationship between UP and SCH in HD patients. The present cross-sectional study included 328 HD patients. All patients were submitted to careful history through clinical examination and standard laboratory assessment. Pruritis was evaluated using the pruritis visual analog scale (VAS). Patients were diagnosed with SCH if they had TSH levels above the upper limit of the normal reference range in association with normal free thyroxine (FT4) levels. Among the studied patients, there were 196 patients (59.8 %) with UP. Comparison between patients with UP and patients without revealed that patients in the former group had significantly longer HD duration (median (IQR): 47.5 (27.0-72.5) versus 36.0 (23.0-50.5) months, p < 0.001) and lower Kt/v (median (IQR): 1.4 (1.09-1.7) versus 1.54 (1.12-1.91), p = 0.009). Moreover, they had significantly higher ferritin (median (IQR): 653.0 (526.0-800.0) versus 628.0 (470.8- 716.0) ng/mL), hsCRP (median (IQR): 12.0 (8.0-14.0) versus 8.0 (6.0-9.0) mg/dL, p < 0.001) and TSH levels (median (IQR): 4.34 (1.98-5.2) versus 3.34 (1.9-4.85) μIU/ml) with a significantly higher frequency of SCH (45.9 % versus 28.8 %, p = 0.002). Logistic regression analysis identified hemodialysis duration (OR (95%) CI): 1.02 (1.009-1.028), p < 0.001), ferritin levels (OR (95% CI): 1.002 (1.001-1.003), p < 0.001), and SCH (OR (95% CI): 0.54 (0.32-0.89), p = 0.016) as significant predictors of UP. The present study suggested a possible link between SCH and the development of UP in HD 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.

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.

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...

Comparison of Pregabalin and Ketotifen in treatment of uremic pruritus in hemodialysis patients.

This study aims to compare the efficiency of Pregabalin and Ketotifen in treatment of uremic pruritus in hemodialysis (HD) patients. Thirty HD patients were randomly divided into two groups: A (Pregabalin 50 mg three times a day) and B (Ketotifen 1mg twice a day). Efficacy of treatment and quality of life were weekly evaluated by visual analogue scale (VAS) and Itchy Quality of life, respectively. There was no significant difference between the two groups regarding demographic features, laboratory data, quality of life, and VAS before treatment. In the second week of treatment, the pruritus intensity was significantly lower in the Pregabalin group than the Ketotifen group (p= 0.026). The mean of life quality was significantly lower in Ketotifen than Pregabalin group in weeks 1, 2, and 4 (p= 0.001, p= 0.001, and p= 0.036, respectively). There was no significant difference between the two groups regarding the side effects of drugs. This study showed that a higher dose of Pregabalin could be a more effective treatment than Ketotifen without additive side effects in improving the quality of life in dialysis patients.

Uremic pruritus: pathophysiology, clinical presentation, and treatments.

Uremic pruritus is one of the most common and bothersome symptoms in patients with end-stage renal disease. Most patients with uremic pruritus experience a prolonged and relapsing course and significant impairments of quality of life. The pathophysiology of uremic pruritus is not completely understood. A complex interplay among cutaneous biology and the nervous and immune systems has been implicated, with the involvement of various inflammatory mediators, neurotransmitters, and opioids. Uremic pruritus treatment outcomes are often unsatisfactory. Clinical trials have mostly been small in scale and have reported inconsistent results. Recent evidence shows that gabapentinoids, nalfurafine, and difelikefalin are effective for relieving uremic pruritus in hemodialysis patients. This review provides an overview of the epidemiology and proposed mechanisms of uremic pruritus, then highlights the manifestations of and clinical approach to uremic pruritus. Current evidence regarding treatment options, including topical treatments, treatment of underlying disease, phototherapy, and systemic treatments, is also outlined. With a better understanding of uremic pruritus, more therapeutic options can be expected in the near future.

An Investigation into the Effects of Omega-3 on Uremic Pruritus in Hemodialysis Patients: A Randomized Crossover Clinical Trial.

Itching along with other problems can be one of the factors exacerbating the sufferings and disturbing the comfort of patients with chronic renal failure. The present research aimed to study the effects of omega-3 on the treatment of uremic pruritus in hemodialysis (HD) patients. In this crossover randomized clinical trial study, 52 HD patients with pruritus were evaluated. After the random assignment of the participants to Group 1 (treatment mode A) (omega-3 plus cetirizine) and Group 2 (treatment mode B) (cetirizine), they received the treatments for six weeks and then after one week washout period, treatments were changed between the two groups. The pruritus severity was measured using the Yosipovitch pruritus questionnaire before the intervention and at the end of each treatment period. The obtained data were analyzed using descriptive statistics, analysis of variance with repeated measures, and Pearson correlation coefficient. The results of this study showed that pruritus severity reduced in both groups, but it was more significant in Group 1 (omega-3 plus cetirizine). The study findings indicated that omega-3 is effective in the reduction of uremic pruritus. Therefore, this supplement can be used as a convenient method for reducing pruritus in HD patients.

Effectiveness of Baby Oil Therapy for Uremic Pruritus in Hemodialysis Patients.

Uremic pruritus is an uncomfortable feeling of discomfort in the skin. When it becomes severe, pruritus leads to sleep disorders, anxiety, depression, and social dysfunction, affecting the quality of life of patients. Pruritus is experienced by approximately 50%-90% of hemodialysis (HD) patients. The main objective of the study was to evaluate the effectiveness of baby oil therapy for uremic pruritus in HD patients and to determine the association between severity of uremic pruritus and selected demographic variables of HD patients. The research design adopted for this study was an experimental, pretest and posttest control group design. The population was HD patients in the age-group of 40-60 years. The conceptual framework of this research was based on the general system theory model. Purposive sampling technique was used and the sample size was 120 HD patients. Results showed that pruritus score was reduced up to 23.7% among experimental group HD patients with pruritus, whereas in the control group, the reduction score was only about 1.3%. It shows the effectiveness of massage with baby oil on uremic pruritus among patients undergoing HD treatment.

Effectiveness of montelukast for uremic pruritus in hemodialysis patients: A protocol for systematic review and meta-analysis.

Background:Uremic pruritus (UP) is a common and tormenting symptom in end-stage renal disease patients undergoing maintenance hemodialysis. An increasing number of studies have been published in recent years to support the effectiveness of montelukast for UP. We will conduct a comprehensive systematic review and meta-analysis to evaluate effectiveness of montelukast for UP in hemodialysis patients.Methods:The following electronic databases were searched: Pubmed, Embase, Web of Science, Cochrane Library, the China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and China Science and Technology Journal Database. The range of publication time was from the inception of the database to December 2020. Two reviewers will independently conduct article selection, data collection, and assessment of risk of bias. Any disagreement will be resolved by discussion with the third reviewer. Meta-analysis will be performed by Review Manager 5.3. The Cochrane Collaboration tool will be used to assess the risk of bias.Results:This study will provide a systematic synthesis of current published data to explore the effectiveness of montelukast for UP in hemodialysis patients.Conclusions:This systematic review and meta-analysis will provide clinical evidence for the effectiveness of montelukast for UP in hemodialysis patients and inform our understanding of the value of montelukast in improving pruritus symptoms. This study will help clinicians, patients, and policy makers to make better decisions regarding the appropriate role of montelukast as a part of patient management routines.Study registration number:INPLASY2020100043.

Comparison of gabapentin and doxepin in the management of uremic pruritus: A randomized crossover clinical trial.

Gabapentin and doxepin are well-known treatments of uremic pruritus in hemodialysis patients but no head-to-head studies were conducted to date. The aim of this trial is to compare the efficacy and the tolerability of gabapentin and doxepin in the treatment of uremic pruritus in hemodialysis patients. A single-blind crossover randomized trial was conducted that included hemodialysis patients with uremic pruritus. Patients were randomized to receive 10 mg doxepin daily or 100 mg gabapentin for 4 weeks and the two groups were treated conversely for another 4 weeks after a 4-week washout period. Eighty-five patients were screened for eligibility. Thirty-one met the inclusion criteria and four were excluded. Sixteen patients agreed and signed the consent and two withdrew from the study. VAS scores at baseline were 6.71 and 6.14, and dropped to 0.57 and 2.35 at week 4 in the gabapentin and doxepin groups, respectively. Mean scores of the 5-Domain Itch Scale (5-D) at baseline were 14.71 and 14.64, and dropped to 5.78 and 7.57 at week 4 in the gabapentin and doxepin groups, respectively. Mean scores of the Dermatology Life Quality Index (DLQI) at baseline were 9.6429 and 8.7857, and dropped to 0.71 and 3.35 at week 4 in the gabapentin and doxepin groups, respectively. Reductions in Visual Analog Scale (VAS), 5-D and DLQI were statistically significant (P < .05). No serious side effects were recorded. Limitations of this study include single-blind design, small number of included cases and lack of placebo control. Gabapentin was more effective than doxepin in decreasing uremic pruritus severity and improving quality of life of these patients.

Therapeutic effect of intravenous sodium thiosulfate for uremic pruritus in hemodialysis patients

Objectives This study aimed to compare the efficacy of intravenous sodium thiosulfate (IV STS) with that of loratadine in the treatment of uremic pruritus in hemodialysis (HD) patients. Methods This retrospective study included 44 HD patients with pruritus aged over 18 years between June 2018 and January 2020 at the Aerospace Center Hospital of China. Twenty-four HD patients received 3.2 g IV STS treatment three times per week at the end of each HD session for 8 weeks. Twenty HD patients received loratadine (10 mg/day) for 8 weeks. Pruritus intensity was measured using a visual analog scale (VAS) and the detailed pruritus score (DPS) at three time points. The safety of STS was evaluated according to adverse event symptoms and biological variable changes. Results There was no significant difference between the STS and loratadine groups in age, sex, characteristics of pruritus, or other clinical variables before treatment. After 8 weeks of treatment, the VAS score (7.07 ± 2.56 and 2.67 ± 2.01) and DPS (30.72 ± 4.81 and 8.04 ± 2.86) decreased significantly in the STS group (p < 0.05). The mean decrease in VAS score (6.89 ± 1.98 and 6.34 ± 2.35) and DPS (28.90 ± 3.24 and 26.92 ± 2.41) in the loratadine group was not statistically significant (p > 0.05). There were no morbidities or mortalities associated with the use of either drug. All biological variables remained stable after therapy. Conclusions STS can improve uremic pruritus in HD patients. However, literature on the subject remains lacking. Close monitoring for adverse effects is advised.

Association of high sensitive C reactive protein and dialysis adequacy with uremic pruritus in hemodialysis patients

ABSTRACT Introduction Uremic pruritus is one of the most common and complicated symptom affecting hemodialysis patients, it can be persistent, distressing and having a significant impact on the quality of life. We aimed to study the relationship between high sensitive C reactive protein and adequacy of dialysis with uremic pruritus in hemodialysis patients. Patients and Methods In this Case control study one hundred prevalent hemodialysis patients were enrolled from hemodialysis units in Ain Shams University hospitals, fifty of them had pruritus and the other fifty patients had no pruritis, all of them underwent urea reduction ratio for dialysis adequacy assessment, pruritus assessment by using visual analog scale and high sensitive C reactive protein serum level. Results Uremic pruritus has statistically significant negative correlation with urea reduction ratio and consequently with dialysis adequacy. However, uremic pruritus has statistically significant positive correlation with highly sensitive C reactive protein serum levels in hemodialysis patients. Conclusion Inadequate hemodialysis and increased hsCRP serum level play an important role in aggravating intensity and severity of uremic pruritus.

Association Between Serum Aluminum Level and Uremic Pruritus in Hemodialysis Patients

Uremic pruritus (UP) is a common symptom in patients undergoing hemodialysis (HD). The pathogenesis of UP is complex. Aluminum (Al) is a common metal and is toxic to patients undergoing HD. Al is also a known human allergen which can induce immune reactions. However, the correlation between Al and UP remains unclear in dialysis patients. A total of 866 patients on maintenance HD were enrolled for analysis. The HD patients with higher serum Al levels had higher a prevalence of UP than those with lower serum Al levels. After adjusting for confounding variables, the serum Al level was significantly associated with UP. Overall, each 10-fold increase in serum Al level was associated with a 5.64-fold increase in the risk of developing UP in these subjects. The results of this cross-sectional study suggest that serum Al level may be associated with the development of UP in patients on maintenance HD.

Vegetarian diet may ameliorate uremic pruritus in hemodialysis patients

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.

PMU7 - Effects of Turmeric on Clinical Conditions: Umbrella Reviews of Systematic Review and Meta-Analysis

To perform umbrella review of systematic reviews and meta-analysis (SR-MA) investigating effects of Turmeric on any clinical condition in human. PUBMED, AMED, EMBASE, and Cochrane Library were searched from inception till December 2017. AMSTAR2 was used to evaluate quality of included studies. We estimated the effect size by using random-effects and fixed-effects models, the 95%Confidence and prediction intervals. The heterogeneity between studies was assessed by I2 (defined as large for I² ≥50%). The small study effects were assessed by funnel plot asymmetry and Egger’s regression test. Whenever more than one SR-MA had been performed on the same clinical condition, we included the one with the largest number of primary studies to avoid duplication. The evidence was graded into convincing, suggestive, or weak. Overall, 22 SR-MA with 53 unique meta-analyses (MA) with moderate-high methodological quality were included. The effects of Turmeric on a wide range of clinical conditions were determined including musculoskeletal pain, joint arthritis, depression, anxiety, Alzheimer, potentially malignant disorders, oral lichen planus, ulcerative colitis, Crohn’s disease, diabetes, metabolic syndrome/dyslipidemia/obesity, uremic pruritus in hemodialysis patients, and skin disorders (acne, facial photoaging, eczema, androgenic alopecia, psoriasis, vitiligo, radio-protective in head-neck, and breast cancer). Among these, Turmeric significant improved health outcomes of knee OA, depression, and metabolic syndrome or dyslipidemia with p-value<0.001 (I²<50%, no small-study effects). Other conditions, except anxiety, Alzheimer, oral lichen planus, androgenic alopecia, and vitiligo were significant improved by Turmeric with p-value<0.05. Since all MA evaluating patients less than 1000 and 95%PI including the null value, evidence grading was weak. Although Turmeric effects showed benefit in several clinical conditions, small sample size limited the quality of evidence. Further large trials need to confirm the benefit of Turmeric on these conditions.

The Effect of Thermal Therapy on Uremic Pruritus in Hemodialysis Patients

The Effect of Thermal Therapy on Uremic Pruritus in Hemodialysis Patients

The effect of the omega-3 supplement on uremic pruritus in hemodialysis patients; a double-blind randomized controlled clinical trial

Background: Chronic kidney disease (CKD) and uremic syndrome cause malfunction in most of organs including skin. Objectives: This study was designed to investigate the effects of omega-3 supplement on uremic pruritus in chronic hemodialysis patients. Patients and Methods: In this double-blind randomized controlled clinical trial study (#IRCT cod; 29363; http://irct.ir/trial/29363), the effect of the omega-3 supplement on uremic pruritus was assessed in 64 chronic hemodialysis patients (using standard 5-D itch scale questionnaire). Patients were surveyed at the hemodialysis department of Imam Khomeini and Razi hospitals in Ahvaz city, Iran. Results: We found that the mean score of itching degree in the intervention and the placebo groups decreased from 3.56 to 1.72 (P&lt;0.001) and 3.63 to 3.09 (P&lt;0.05) respectively. Conclusions: In our study, the omega-3 supplement could reduce uremic pruritus in chronic hemodialysis patients.

The Effect of Increasing Blood Flow Rate on Severity of Uremic Pruritus in Hemodialysis Patients: A Single Clinical Trial

BackgroundAlthough the prevalence of uremic pruritus has decreased compared to the past, the problem still remains as a matter of health and a major challenge of research in medical field, and has no effective treatment at present. This study aimed to investigate the effect of increasing blood flow rate on severity of uremic pruritus in hemodialysis patients in Iran. MethodsThis clinical trial was performed on 60 hemodialysis patients that referred to hospitals affiliated to Tehran University of Medical Sciences and these patients were selected through the convenience method and were treated for four weeks. They were divided into two groups of experimental and control as random allocation block, and studied for 4 weeks. Information on pruritus severity was collected using a researcher-made questionnaire in three steps of before intervention and two and four weeks after start of intervention. The rate of blood flow was increased in the first two weeks and the second two weeks by 25 and 50 rounds per minute (rpm) compared to the mean rate of blood flow of hemodialysis device in the last two sessions before intervention. Data were analyzed using the tests Mann–Whitney, Fisher, and t-test. ResultsAnalysis of data from 50 persons in both groups who completed the study revealed a significant difference between the groups in the severity of pruritus between the two sessions of hemodialysis (pruritus at home) at the end of the first two weeks of the intervention (<0.05) and the number of cases of pruritus (<0.05) at the end of the study. ConclusionsIncreasing blood flow for hemodialysis machine can induce significant statistical and clinical reduction in the severity and the frequency of pruritus in hemodialysis patients and can be help to be improve the quality of life of these persons by increased the blood flow rate.

Association of uremic pruritus in hemodialysis patients with the number of days of high mean 24-hour particulate matter with a diameter of

Uremic pruritus (UP) is a common and incapacitating symptom in patients undergoing hemodialysis (HD). The pathogenesis of UP is multifactorial and complex. Particulate matter (PM), a major air pollutant, is a mixture of particles with various chemical compositions. PM is associated with several allergic diseases, including dermatitis. To assess the role of PM (PM with a diameter of <10 μm [PM10] and PM with a diameter of <2.5 μm [PM2.5]) and other clinical variables in UP in patients on HD, we recruited 866 patients on maintenance HD (MHD). We analyzed the number of days of mean 24-hour PM10 ≥125 μg/m3/12 months (NDPM10) or the number of days of mean 24-hour PM2.5 ≥35 μg/m3/12 months (NDPM2.5) exceeding the standard level in the past 12 months respectively to determine the association with UP. In a multivariate logistic regression, HD duration, serum ferritin levels, low-density lipoprotein (LDL) levels, and NDPM2.5 ≥116 days/12 months were positively associated with UP. This cross-sectional study showed that the number of days on which the environmental PM2.5 exceeds the standard level might be associated with UP in patients on MHD.