A Clinical Study Of Pruritus In Chronic Renal Failure Patients

Background:Skin is one of the largest organ in the body, it is also the first nature defence of the human body. It has several important functions, chief among which are barrier, immunology, metabolism and thermoregulation, which is very important for human survival. The changes of internal milieu of the body are readily reflected on the skin. Accordingly, it makes an interesting way to study many aspects of the human body by studying skin lesions. Chronic kidney disease is one of the most common systemic disease to cause the skin changes. Patients with renal failure, especially end-stage renal disease (ESRD), commonly are afflicted by severe pruritus. Pruritus remains one of the most common and bothersome symptoms in uremia patients. Although, a recent study suggests that the prevalence of pruritus is significantly decreasing as a result of general dialysis and better dialysis techniques, uremic pruritus is still a major problem for patients with ESRD, the prevalence of uremic pruritus ranges from50%to90%as report from abroad.Despite the high prevalence of pruritus, the data regarding the clinical characteristics is sparse, partly because the difficulties in studying the symptom that has a subjective and complex nature.Objective:The study aimed at a comprehensive understanding of the prevalence, clinical features and possible influencing factors of skin itch in the patients with chronic kidney disease, providing new data of pruritus with CRF.Methods:A total of478hospitalized CRF patients were screened for pruritus in the second hospital of Lanzhou University for a period from2012.06～2012.12, including173patients undergoing hemodialysis,51patients for peritoneal dialysis and254CRF patients. Excluded patients because of communication problem or patients’refusal. A comprehensive questionnaire was designed to evaluate and measure various aspects of pruritus. Using visual analogue scale(VAS) to assess the intensity of the itch in4different temporal state, the subject was asked to mark the intensity of the itch. Eventually using SPSS13.0software for analysis, We examined relationship of the various factors and itch.Results:In the investigate population, pruritus is a common symptom.256(51.6%) patients afflicted with pruritus, including95patients with CRF and151patients undergoing dialysis. It was more prevalent in patients receiving hemodialysis than peritoneal dialysis(69%vs61%). In the study,234patients suffered with dry skin,136patients at the same time catching with itchy skin. The study confirmed that effective and regular dialysis can relieve pruritus,61patients(40%) relieved their pruritus.125patients (50%) pointed out hot shower relieve their pruritus;142patients (57%) relieved pruritus in cold shower, in47patients (19%), cold temperature were associated with a decrease in pruritus. The intensity of uremic pruritus ranged from sporadic discomfort to complete restlessness during day and night. It may be intermittent or persistent. It may be localized or generalized. In85%of the patients, the involvement was symmetrical. Pruritus may lead to skin lesion, There were194(78%),220(89%) of pruritus patients complain of disturbance to sleep and mood. In spite of this, but only37%of patients receiving treatment, curative effect was poor, our research showed that the extent of pruritus had correlation with the levels of urea, creatinine, PTH, phosphorus in serum and calcium×phosphorus.Conclusion:1. Pruritus is a common symptom in patients with CRF, most patients deeply plague by itching, impairing their Physical and mental health. There is no relation between occurrence of pruritus and demographic parameters of the patients, the duration of the disease having relationship with pruritus.2. The xerosis is the most common skin manifestation of chronic renal failure patients, having correlation with the incidence of pruritus.The location and duration of pruritus vary greatly, cold, hot stimulus or cold climate can relieve pruritus in some extent. Sufficiency hemodialysis can also relieve pruritus.3. Serum urea nitrogen, creatinine, phosphorus, calcium-phosphorus product and PTH level are considered to have relationship with pruritus.