Uremic Pruritus Research Articles

Effect of manual acupressure (points SP6, SP10, ST36, and LI11) on the uremic pruritus and quality of life in hemodialysis patients: A parallel, randomized controlled trial

The present study was conducted to determine the effect of manual acupressure on uremic pruritus and quality of life (QoL) in patients undergoing hemodialysis. This randomized controlled trial was conducted with a pre-post design on 90 patients with hemodialysis in southern Iran. The patients were divided into three groups using block randomization: intervention, sham control, and passive control. The intervention group received acupressure on SP6, SP10, ST36, and LI11 points. In the sham group, pressure was exerted on sham points two Cuns away from the actual points, and the passive control group solely received routine treatment. The intervention was carried out three times a week for four weeks. The patient's QoL was evaluated before and after the intervention using the Itchy QoL scale, and the dimensions of itching were assessed before the intervention and two and five weeks after commencing the intervention using the 5-D Pruritus scale. The groups' QoL and itching parameters were the same before the intervention. The analysis of variance (ANOVA) showed significant differences among the groups in terms of QoL following intervention. This index improved significantly in the intervention group compared to the other groups (P<0.001, G1=107.20 (standard deviation [SD]=5.45)). Repeated measures ANOVA showed that acupressure significantly reduced the severity and duration of itching and the number of itching points in the intervention group. Acupressure can improve hemodialysis patients' QoL and itching sensations. Being a non-pharmaceutical, risk-free, and inexpensive method, this intervention could be recommended to be used for relieving uremic pruritus.

Association between Dietary Fiber Intake and Uremic Pruritus in Patients with CKD

Association between Dietary Fiber Intake and Uremic Pruritus in Patients with CKD

Evaluation of Interleukin-31 Serum Levels in Patients with Chronic Kidney Disease on Hemodialysis with and without Uremic Pruritus

الخلاصة: الحكة اليوريمية لدى مرضى غسيل الكلى يؤثر على أكثر من 40٪ من المرضى. وربما ترتبط الحكة المستمرة بمستويات عالية من الإنترلوكين 31. الاهداف: النظر إلى مستويات مصل إنترلوكين 31 لدى مرضى غسيل الكلى المصابين بمرض الكلى في المرحلة النهائية، سواء مع أو بدون حكة يوريمية. النتائج: لم يكن مستوى المصل [الوسيط (] لـ IL-31 في المرضى الذين يعانون من الحكة اليوريميةأو بدون حكة في عينة مصل ما قبل غسيل الكلى مختلفًا بشكل ملحوظ [1395.75(624.75) بيكوغرام/مل و1361.55 (741.96) بيكوغرام/مل، على التوالي]؛ (فيمة الاحتمال = 0.36). من ناحية أخرى، كان لدى المرضى الذين يعانون من الحكة اليوريمية مستوى كرياتينين في الدم أعلى بكثير [9.8(5.5) ملغم/ديسيلتر] من المرضى الذين لا يعانون منها [8.15(3.18) ملغم/ديسيلتر] (قيمة الاحتمال = 0.02). لم يكن هناك اختلاف كبير في مستويات مصل الباراثورمون أو الكالسيوم أو اليوريا السليمة بين المرضى الذين يعانون من أو بدون UP (P> 0.05). كان متوسط ​​(IQR) لمصل IL-31 في المرضى الذين يعانون من UPالحكة والمرضى الذين لا يعانون منها مختلفًا بشكل كبير، عند 1435 (601.61) بيكوغرام/مل و873.45 (109.54) بيكوغرام/مل، على التوالي، قبل وبعد جلسات غسيل الكلى (P <0.001).). كان لدى المرضى الذين لا يعانون من الحكة مستوى IL-31 أكبر بشكل غير ملحوظ في عينة مصل ما بعد غسيل الكلى [879.7(84.19) بيكوغرام/مل] من المرضى الذين يعانون من حكة [864 (164.58) بيكوغرام/مل] (P = 0831). الاستنتاج: مستويات المصل IL-31 لدى مرضى مرض الكلى في المرحلة النهائية الذين يعانون من الحكة اليوريمية ليس لها أي دور في الحكة. الخلاصة: الحكة اليوريمية لدى مرضى غسيل الكلى يؤثر على أكثر من 40٪ من المرضى. وربما ترتبط الحكة المستمرة بمستويات عالية من الإنترلوكين 31. الاهداف: النظر إلى مستويات مصل إنترلوكين 31 لدى مرضى غسيل الكلى المصابين بمرض الكلى في المرحلة النهائية، سواء مع أو بدون حكة يوريمية. النتائج: لم يكن مستوى المصل [الوسيط (] لـ IL-31 في المرضى الذين يعانون من الحكة اليوريميةأو بدون حكة في عينة مصل ما قبل غسيل الكلى مختلفًا بشكل ملحوظ [1395.75(624.75) بيكوغرام/مل و1361.55 (741.96) بيكوغرام/مل، على التوالي]؛ (فيمة الاحتمال = 0.36). من ناحية أخرى، كان لدى المرضى الذين يعانون من الحكة اليوريمية مستوى كرياتينين في الدم أعلى بكثير [9.8(5.5) ملغم/ديسيلتر] من المرضى الذين لا يعانون منها [8.15(3.18) ملغم/ديسيلتر] (قيمة الاحتمال = 0.02). لم يكن هناك اختلاف كبير في مستويات مصل الباراثورمون أو الكالسيوم أو اليوريا السليمة بين المرضى الذين يعانون من أو بدون UP (P> 0.05). كان متوسط ​​(IQR) لمصل IL-31 في المرضى الذين يعانون من UPالحكة والمرضى الذين لا يعانون منها مختلفًا بشكل كبير، عند 1435 (601.61) بيكوغرام/مل و873.45 (109.54) بيكوغرام/مل، على التوالي، قبل وبعد جلسات غسيل الكلى (P <0.001).). كان لدى المرضى الذين لا يعانون من الحكة مستوى IL-31 أكبر بشكل غير ملحوظ في عينة مصل ما بعد غسيل الكلى [879.7(84.19) بيكوغرام/مل] من المرضى الذين يعانون من حكة [864 (164.58) بيكوغرام/مل] (P = 0831). الاستنتاج: مستويات المصل IL-31 لدى مرضى مرض الكلى في المرحلة النهائية الذين يعانون من الحكة اليوريمية ليس لها أي دور في الحكة. الخلاصة: الحكة اليوريمية لدى مرضى غسيل الكلى يؤثر على أكثر من 40٪ من المرضى. وربما ترتبط الحكة المستمرة بمستويات عالية من الإنترلوكين 31. الاهداف: النظر إلى مستويات مصل إنترلوكين 31 لدى مرضى غسيل الكلى المصابين بمرض الكلى في المرحلة النهائية، سواء مع أو بدون حكة يوريمية. النتائج: لم يكن مستوى المصل [الوسيط (] لـ IL-31 في المرضى الذين يعانون من الحكة اليوريميةأو بدون حكة في عينة مصل ما قبل غسيل الكلى مختلفًا بشكل ملحوظ [1395.75(624.75) بيكوغرام/مل و1361.55 (741.96) بيكوغرام/مل، على التوالي]؛ (فيمة الاحتمال = 0.36). من ناحية أخرى، كان لدى المرضى الذين يعانون من الحكة اليوريمية مستوى كرياتينين في الدم أعلى بكثير [9.8(5.5) ملغم/ديسيلتر] من المرضى الذين لا يعانون منها [8.15(3.18) ملغم/ديسيلتر] (قيمة الاحتمال = 0.02). لم يكن هناك اختلاف كبير في مستويات مصل الباراثورمون أو الكالسيوم أو اليوريا السليمة بين المرضى الذين يعانون من أو بدون UP (P> 0.05). كان متوسط ​​(IQR) لمصل IL-31 في المرضى الذين يعانون من UPالحكة والمرضى الذين لا يعانون منها مختلفًا بشكل كبير، عند 1435 (601.61) بيكوغرام/مل و873.45 (109.54) بيكوغرام/مل، على التوالي، قبل وبعد جلسات غسيل الكلى (P <0.001).). كان لدى المرضى الذين لا يعانون من الحكة مستوى IL-31 أكبر بشكل غير ملحوظ في عينة مصل ما بعد غسيل الكلى [879.7(84.19) بيكوغرام/مل] من المرضى الذين يعانون من حكة [864 (164.58) بيكوغرام/مل] (P = 0831). الاستنتاج: مستويات المصل IL-31 لدى مرضى مرض الكلى في المرحلة النهائية الذين يعانون من الحكة اليوريمية ليس لها أي دور في الحكة.

Comparison Between Pregabalin and Sertraline for Treatment of Uraemic Pruritus in Patients on Maintenance Haemodialysis: A Single-Centric Study.

To compare oral pregabalin with oral sertraline for treatment of uraemic pruritus. Randomised controlled trial. Place and Duration of the Study: Department of Nephrology, Pak Emirates Military Hospital Rawalpindi, Pakistan, from October 2023 to January 2024. Patients with end-stage renal disease having pruritus for at least 6 weeks were included. Exclusion criteria comprised other dermatological or systemic diseases associated with pruritus, mental health issues, thrice-a-week haemodialysis schedule, and use of other treatments for uraemic pruritus. They were randomised to receive either pregabalin 75mg daily or sertraline 50mg daily for six weeks using computer-generated sequences. The Urdu version of the 5-D Itch scale was used to document the severity of pruritus at the baseline and at the end of therapy. Side effects to the treatment were also monitored. There were 8 (16.67%) females and 40 (83.33%) males, with a mean age of 52.19 ± 12.19 years. The baseline 5-D Itch scale scores were equal in both groups. Mean improvement in 5-D Itch scale scores was 3.75 ± 1.26 and 2.08 ± 1.18 with pregabalin and sertraline, respectively (p <0.001). Side effects were reported by 2 (8.33%) patients on pregabalin and none using sertraline (p = 0.489). Pregabalin was found to be more effective than sertraline in treating uraemic pruritus, though with a statistically insignificant trend towards a higher frequency of side effects. Chronic renal failure, Pruritus, Renal dialysis, Selective serotonin reuptake inhibitors, Uraemia.

Clinical Assessment and Risk Factors of Uremic Pruritus among Hemodialysis Patients

Clinical Assessment and Risk Factors of Uremic Pruritus among Hemodialysis Patients

Pharmacological interventions for pruritus in adult palliative care patients.

Pharmacological interventions for pruritus in adult palliative care patients.

Comparison Between Pregabalin and Sertraline in the Treatment of Uremic Pruritus in Patients With Maintenance Hemodialysis.

Introduction Pruritus, a medical symptom also known as itch, is characterized by an unpleasant feeling coupled with the urge to scratch. Patients with chronic kidney disease (CKD) often have symptoms of pruritus due to uremia, which has adversely affected their quality of life. The treatment protocol for CKD pruritus is still being debated due to its unclear etiopathogenesis. Pregabalin, an anticonvulsant medication, and sertraline, an antidepressant medication, have been used to treat uremic pruritus (UP) patients on maintenance hemodialysis. Objectives There are no adequate investigations comparing the efficacy of pregabalin and sertraline, particularly in under-resourced countries such as Pakistan. Method The research was a randomized trial for a period of four weeks at the nephrology department of the Mayo Hospital, Lahore. A total of 62 patients were randomly assigned to take either pregabalin (aged 48.06±13.44) or sertraline (aged 47.45±10.97) tablet once a day, a total of 31 patients to each group. The pregabalin group was specified 25 mg for the first week, 50 mg for the second week, and 75 mg for the third and fourth week. Similarly, sertraline was prescribed 25 mg for the first week and 50 mg for the remaining three weeks. However, if the patient shows improvement on the lowest dosage, therapy with the same minimum dose was proposed to be continued. Lastly, the itching score was assessed on the 5D pruritus scale. The Visit 1 (no drug) score was evaluated against post-therapy scores at two-week intervals as Visit 2 (week 2) and Visit 3 (week 4). Statistical analysis was done using the Statistical Product and Service Solutions (SPSS, version 26;IBM SPSS Statistics for Windows, Armonk, NY) with a significance level set at p<0.05 and 95% confidence level. Conclusion This research concluded that both pregabalin and sertraline significantly improved itching intensity in each treatment group; however, there was no significant difference between the two drugs in reducing UP based on the 5D itching scores. In each domain of the 5D pruritus scale, a significant difference was found in post-follow-up pregabalin and sertraline therapy.

Analysis of the Effect and Value of Combined Chinese and Western Medicine in the Treatment of Uremic Pruritus

Objective: To analyze the effect of combined Chinese and Western medicine therapy in patients with uremic pruritus. Methods: 80 cases were randomly selected from uremic pruritus patients from January 2022 to October 2023, and were divided into Group A (40 cases, pure Western medicine therapy) and Group B (40 cases, combined Chinese and Western medicine therapy) by the numerical envelope method to compare the treatment effects of the two groups. Results: The levels of clinical symptom scores (itching degree, itching area, dry skin, secondary lesions) and test indexes (high-sensitivity C-reactive protein, tumor necrosis factor-α, interleukin-6, 5-hydroxytryptamine, blood phosphorus, parathyroid hormone) in Group B were lower than those in Group A after treatment (P &lt; 0.05). Conclusion: Uremic pruritus patients can rapidly improve their clinical symptoms by using combined Chinese and Western medicine therapy.

Clinical Research Progress on Using κ-Opioid Receptor Agonists to Treat Uremic Pruritus

Uremic pruritus, a severe complication in patients with chronic kidney disease, is associated with a high prevalence. It can cause depression and sleep disorders, and seriously affect the quality of life and the social relations of patients. Recently, there is growing evidence showing that κ-opioid receptor agonists, including nalfurafine, difelikefalin, and nalbuphine, can effectively and safely reduce itching symptoms in patients with refractory uremic pruritus. Herein, we reviewed the epidemiology, pathogenesis, clinical symptoms, and treatment strategies of uremic pruritus, and summarized in detail the progress in clinical research on the use of κ-opioid receptor agonists, including nalfurafine, difelikefalin, and nalbuphine, in the management of patients with uremic pruritus.

Stigma in maintenance hemodialysis patients: A cross-sectional study

This study aimed to explore stigma and its predictors among patients undergoing maintenance hemodialysis. We utilized corresponding scales to measure both stigma and quality of life, and examining their correlations. Clinical and laboratory data were obtained through self-reported scales and medical records, screening for possible predictors associated with stigma. We recruited 115 patients in this study, with an average age of 52.14 &amp;plusmn; 11.84 years. The level of stigma indicated correlations with all modules of the SF-36 scale. Specifically, bodily pain, general health, vitality, social functioning, role-emotional, and mental health modules had significant relationships with stigma (P &lt; 0.05). Internalized stigma was significantly related to uremic pruritus and the duration of hemodialysis (P &lt; 0.05). Enacted stigma revealed a significant relationship with uremic pruritus, the Beck Depression Inventory score, and the Beck Anxiety Inventory score (P &lt; 0.05). Overall, stigma appears to exert negative impacts on the quality of life of patients undergoing incident hemodialysis. The occurrence of internalized stigma may be related to uremic pruritus and the duration of hemodialysis, while enacted stigma may be associated with uremic pruritus, depression, and anxiety.

Nomogram to Estimate the Risk of Chronic Kidney Disease-Associated Pruritus in Patients with End-Stage Renal Disease Undergoing Peritoneal Dialysis: Model Development and Validation Study

Plain Language SummaryWe conducted a study to better understand and predict the risk of CKD-associated pruritus, a common itching condition in patients with severe kidney disease undergoing peritoneal dialysis. Our research included an analysis of the risk factors associated with this condition. Using information from uremic pruritus patients, we developed a special tool that takes into account factors such as a patient’s age, certain blood markers, hemoglobin levels, residual urine volume, and renal Kt/V. This tool is designed to help doctors estimate a patient’s likelihood of developing CKD-associated pruritus. Our results show that this tool is not only accurate but also practical for use in medical settings, aiding doctors in making informed treatment decisions.

Therapeutic Effects of Statins: Promising Drug for Topical and Transdermal Administration.

Statins are HMG-CoA reductase inhibitors and decrease plasma low-density lipoprotein cholesterol (LDL-C) levels. They are well tolerated, and because of their LDL-C-lowering effect, they are utilized to decrease the risk of atherosclerosis and cardiovascular disease. However, statins have pleiotropic effects, including immunomodulatory, anti-inflammatory, antioxidant, and anticancer. Currently, oral administration is the only Food and Drug Administration (FDA)-approved route of administration for statins. However, other administration routes have demonstrated promising results in different pre-clinical and clinical studies. For instance, statins also seem beneficial in dermatitis, psoriasis, vitiligo, hirsutism, uremic pruritus, and graft-versus-host disease. Topically applied statins have been studied to treat seborrhea, acne, rhinophyma, and rosacea. They also have beneficial effects in contact dermatitis and wound healing in animal studies, (HIV) infection, osseointegration, porokeratosis, and some ophthalmologic diseases. Topical and transdermal application of statins is a non-invasive drug administration method that has shown significant results in bypassing the first-pass metabolism in the liver, thereby reducing possible adverse effects. This study reviews the multifaceted molecular and cellular impacts of statins, their topical and transdermal application, novel delivery systems, such as nanosystems for topical and transdermal administration and the challenges concerning this approach.

Blood Purification for the Treatment of Chronic Kidney Disease-associated Pruritus

ABSTRACT Chronic kidney diseases-associated pruritus (CKD-aP) is a term that indicates the itching associated to end stage kidney disease without any apparent cause. This symptom leads to decreased quality of life and increased risk of long-term morbidities and mortality. The pathogenesis of uremic pruritus is still unknown, however, different theories have merged: uremic toxins deposition, immune system dysregulation, peripheral neuropathy, and opioid imbalance. While in the last decade, research focused prevalently on pharmaceutical treatment of CKD-aP, extracorporeal therapies have also evolved providing an alternative but efficient treatment option. In this review, we assess the role of different extracorporeal methods on the treatment of CKD-aP.

#1999 Retrospective observational study of uremic pruritus prevalence on dialysis

Abstract Background and Aims In Spain, the prevalence of moderate-severe Uremic Pruritus (UP) was 46% and 40% in the DOPPS I and DOPPS. This symptom is usually underdiagnosed and could worsen the quality of life, as some recent studies have revealed. The last reports regarding UP prevalence date back to 2004, hence we decided to assess its current frequency of this while exploring the degree of recognition along with other UP-associated factors. Method This study includes 192 patients in renal replacement therapy (RRT), retrospectively recruited from our centre. Data were collected from revisit medical records in 2021. UP was evaluated using a visual analogic scale (VAS). In addition, age, time on dialysis, UP treatment, haemoglobin, eosinophils, plasma levels of calcium, phosphorus, urea, parathyroid hormone, c-reactive protein (CRP), and clearance (measured by KT/V) were also recorded. Results Average patient age was 61.3 years old, with an average time in dialysis of 37.4 months. The most common group of chronic kidney disease was glomerular diseases (25.5%). The patient distribution by RRT was: 51.9% in haemodialysis (HD), 36.5% in peritoneal dialysis (PD), and 11.6% in home haemodialysis (HHD). UP average prevalence was 56.7% (50% in HHD, 55.2% in HD and 60.9% in PD), of which 69.8% had a VAS ≥ 5. UP was statistically associated with older age (p = 0.017) and higher plasmatic phosphorus (p = 0.015). Notably, only 51.9% UP patients had been prescribed specific drugs for itching. Among UP treated patients, 70.9% improved 3 or more VAS points (with no differences among drugs). Interestingly, this improvement was associated with lower calcium levels (p &amp;lt; 0.0001), the absence of peripheral artery disease (PAD) (p = 0.035), and the shortest time on dialysis (p = 0.001). Conclusion Despite the advances made in HD techniques and the recent incorporation of biocompatible solutions in PD, UP remains a frequent symptom among dialysis patients, without relevant prevalence improvements over the last 20 years. UP was misdiagnosed and mistreated in our unit, since just 51.9% of patients with UP were under treatment. In addition, clinical response to treatment was appropriate in 70.9% of patients, and our results suggest that calcium, PAD, and time on dialysis could predict the response to the treatment. Therefore, our study supports previous data, highlighting UP as a frequent underdiagnosed symptom among dialysis patients; and opens the path for new research in the identification of novel prognosis markers.

#3142 Evaluation of antipruritic effect of tacrolimus on hemodialysis patients with uremic pruritus, a double-blind, randomized, clinical trial

Abstract Background and Aims Pruritus in patients undergoing hemodialysis is a highly prevalent complication that affects quality of life. Several medications are currently used for the treatment of uremic pruritus, but these are not satisfactory. There are few studies about the beneficial effect of oral Tacrolimus on dermatologic problems such as pruritus. Considering the condition of hemodialysis in ESKD patients and the probable presence of oral Tacrolimus in their future treatment plan, this trial is designed to assess the antipruritic effect of Tacrolimus compared with placebo. Method This multicenter, randomized, double-blind, placebo-controlled clinical trial included 75 patients undergoing hemodialysis. The patients were randomized to a treatment group (Tacrolimus 1 mg/day) or a control group (placebo). The treatment lasted eight weeks, followed by a 2-week observational period. Visual Analogue Scale (VAS), % affected Body Surface Area (%BSA), and 12-Pruritus Severity Scale questionnaire (12-PSS) were measured before and after treatment periods. Moreover, sleep quality and the effect of sex were also evaluated. Results Seventy-five patients under hemodialysis (mean age of 58.18 ± 09.39 years) completed the study. Mean changes in VAS, %BSA, and 12-PSS after the interventions (Tacrolimus vs. placebo, mean ± SD) were as follows, respectively: −3.77 ± 2.13 vs. −1.07 ± 1.17, −18.97 ± 12.20 vs. 2.44 ± 3.23, and −4.67 ± 3.21 vs. −1.32 ± 2.45 (P &amp;lt; 0.0001). An improvement in sleep quality was found in 52.6% (20/38) of patients after Tacrolimus intake (P &amp;lt; 0.01). Overall, Tacrolimus was more effective in women than men (P &amp;lt; 0.016). Conclusion Based on the preliminary results of this study, Tacrolimus can be introduced as an effective drug for the management of pruritus and can be an add-on therapy in uremic patients.

Perawatan Topikal Berbasis Minyak pada Pasien Pruritus Uremik dengan Gagal Ginjal Kronis

The aim of this study was to look at oil-based topical treatments that are effective in reducing and reducing the scale of uremic pruritus in patients with chronic kidney failure. The research method used in writing this systematic review was a literature search conducted through the Pubmed, Proquest, Science direct, Scopus databases with articles selected from 2010-2022. The results of this study showed a significant reduction in the scale of uremic pruritus in chronic kidney failure patients within 1-4 weeks of oil-based topical treatment. In conclusion, oil-based topical treatments are effective in reducing complaints of itching and pruritus in chronic kidney failure patients so that they can be used in nursing treatment. Key Word: Chronic Renal Failure; Oil Based Treatment ; Uremic Pruritus

Psychometric evaluation of the multidimensional Uraemic Pruritus in Dialysis patients (UP-Dial) scale: comparison of haemodialysis and peritoneal dialysis patients with chronic pruritus.

High-quality patient-reported outcome (PRO) measures for dialysis patients with chronic pruritus are urgently needed. However, no known, well-validated multidimensional tools have been investigated to measure pruritus symptoms in dialysis patients. To examine the psychometric properties of a multidimensional tool of chronic pruritus, the Uraemic Pruritus in Dialysis patients (UP-Dial) 14-item scale, by comparing haemodialysis and peritoneal dialysis modality. This validation study used data from the Thai Renal Outcomes Research-Uraemic Pruritus, a prospective, multicentre, longitudinal study. Data for this study were collected from 1 February 2019 to 31 May 2022. The adult sample of 226 haemodialysis and 327 peritoneal dialysis patients fulfilled the criteria of chronic pruritus based on the International Forum for the Study of Itch. Psychometric properties of the UP-Dial included validity and reliability, as measured across haemodialysis and peritoneal dialysis patients. Patients completed a set of anchor-based measurement tools, including global itching, Dermatology Life Quality Index (DLQI), EuroQoL-5 dimension-5 level (EQ-5D-5L), Kidney Disease Quality of Life-36 (KDQOL-36), Pittsburgh Sleep Quality Index (PSQI), global fatigue, Somatic Symptom Scale-8 (SSS-8) and Patient Health Questionnaire-9 (PHQ-9). From the patient's perspective, face validity was satisfactory for both dialysis samples. Psychometric analyses of the UP-Dial for each dialysis sample had good convergent validity. Spearman rho correlations indicate a positively strong correlation (0.73-0.74) with global itching, a positively moderate correlation (0.33-0.58) with DLQI, PSQI, global fatigue, SSS-8 and PHQ-9, and a negatively moderate correlation (-0.39 to -0.58) with EQ-5D-5L and KDQOL-36. The discriminant validity was satisfactory with a group of moderate and severe burden of pruritus for both dialysis samples. For scale reliability, the UP-Dial revealed excellent internal consistency (Cronbach's α = 0.89 and McDonald's ω = 0.90) and reproducibility (intraclass correlation 0.84-0.85) for both dialysis samples. Regarding psychometric properties, no statistically significant differences between dialysis samples were observed (all P > 0.05). The findings reaffirm good measurement properties of the UP-Dial 14-item scale in haemodialysis and peritoneal dialysis patients with chronic pruritus. These suggest a transferability of the UP-Dial as a PRO measure in clinical trial and practice settings.

Data independent acquisition reveals in-depth serum proteome changes in uremic pruritus.

Introduction: Uremic pruritus (UP) is a prevalent symptom in patients suffering from uremia, yet its underlying etiology and mechanisms remain incompletely elucidated. Given the significant incidence of UP, identifying specific alterations in proteins present in the blood of UP patients could offer insights into the potential biological pathways associated with UP and facilitate the exploration of biomarkers. Methods: In this study, we employed LC-MS/MS-based data-independent acquisition (DIA) mode to analyze serum samples obtained from 54 UP patients categorized as DKD-UP, HN-UP, and GN-UP (n = 18 for each subgroup), along with 18 uremic patients without pruritus (Negative) and 18 CKD patients without pruritus (CKD). Through DIA mode analysis, a total of 7075 peptides and 959 proteins were quantified. Within these, we identified four upregulated and 13 downregulated Differentially Expressed Proteins (DEPs) in DKD-UP versus Negative, five upregulated and 22 downregulated DEPs in HN-UP versus Negative, and three upregulated and 23 downregulated DEPs in GN-UP versus Negative. Furthermore, we conducted an intersection analysis of the DEPs across these three comparison groups to derive a set of common DEPs (COMP). Subsequently, a total of 67 common DEPs were identified in the three UP groups when compared to the CKD group, with 40 DEPs showing upregulation and 27 DEPs displaying downregulation. Results: Following Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Protein-Protein Interaction (PPI) analyses, we observed that the DEPs distinguishing UP from CKD were primarily associated with mitochondrial function (MT-CYB, PRDX2, TOMM22), inflammation (CD59, CSF1), renal injury (WFDC2), and neural function (CAP1, VGF). Discussion: Our findings contribute to a potential molecular comprehension of UP pathogenesis, shedding light on the identification of these DEPs as plausible biomarkers for UP.

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

&lt;p class="TableParagraph"&gt;&lt;strong&gt;Background: &lt;/strong&gt;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.&lt;/p&gt;&lt;p class="TableParagraph"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p class="TableParagraph"&gt;&lt;strong&gt;Result: &lt;/strong&gt;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.&lt;/p&gt;&lt;p class="TableParagraph"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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.&lt;/p&gt;

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.