Influence Factors And Intervention On Skin Itching In Patients With Maintenance Hemodialysis

Background:The skin itch problem in patients with maintenance hemodialysis?MHD?is a more common and extremely painful problem in patients with hemo-dialysis?HD?^[1],And The incidence of skin itching in patients with MHD can reach22%⁹0%during the dialysis period^[2]Skin itching is an increasingly important problem in dialysis patients and it has a negative impact on the quality of life,sleep,emotional state and social relations of MHD patients.As a result,the quality of life of patients with MHD has become a problem that kidney physicians need to pay attention to,although at this stage there have been many hypotheses about the cause of skin itching in patients with MHD.However,the reasons for its development are still not completely clear^[3],Although there are many methods to try to determine the risk factors for skin itching in MHD patients,including calcium?Calium,Ca?and phosphate levels,leptin,dialysis adequacy,depression,and anxiety,etc.Whether these factors are the causes of their occurrence is still controversial^[4],And Based on the above reasons,this study attempts to explore the risk factors of skin itching in patients with MHD,and uses different blood purification methods to effectively intervene in them,so as to achieve the purpose of reducing skin itching in patients with MHD,and thereby improve the physiological and mental health of patients with MHD.At the same time,under the existing medical and technical conditions,coupled with the coverage of universal medical insurance,most MHD patients have the same ability to work as normal people and have the same willingness to work.All sectors of society should actively encourage uremia patients to return to work,thereby reducing the social and uremia patients'family burden.So that uremia patients can be self-sufficient,form a virtuous cycle,and then improve the quality of life of uremia patients.Part one:Investigation of skin itching and its influencing factors in MHD patients with multiple centers in luoyang city.Objective:To investigate the occurrence of pruritus in patients with Maintainable Hemodialysis?MHD?in Luoyang,and to analyze the influencing factors of pruritus in patients with MHD.Methods:Select seven blood purification centers in Luoyang from January 2016 to June2016 including The Third People's Hospital Of Luoyang,The Center Hospital Affilifated To Zhengzhou University,The First Affiliated Hospital Of Henan University of Science and Technology,The Third Affiliated Hospital Of Henan University of Science and Technology,The First Hospital of Traditional Chinese Medicine,The Second Hospital of Traditional Chinese Medicine,The 150^th Hospital of Chinese People's Liberation Army for MHD treatment of chronic kidney disease stage5?CKD-5?and had been undergoing hemodialysis for more than 3 months,except those with visual,hearing and communication disabilities;Serious acute infections and severe heart and lung diseases have occurred in the past three months.A total of 352patients were included,of which 201 were males and 151 were females.The basic data collected for selected patients include primary morbidity,dialysis age,age,sex,nutritional status,and laboratory examination indicators including Hemoglobin?Hb?,parathyroid hormone,and Blood Calcium?Ca?,Phosphorus,?P?,urea nitrogen?BUN?,leptin?Lep?,?₂-microglobulin??₂-MG?,C Reaction Protein?CRP?,calculated Kt/V using the Daugirdas method,and the same SF-36?the MOS item short report health?.The staff trained in the SF-36 scale conducted a questionnaire survey of selected patients on the Duo's improved itch score scale in the SF-36.Calculating the questionnaire scores of all patients,352 patients with maintenance hemodialysis were divided into two groups based on the presence of skin itching:161 cases of skin itching and 191 cases of non-skin itching.To compare the difference between two groups,age,sex,dialysis age,hemoglobin,blood calcium,blood phosphorus,parathyroid hormone,urea nitrogen,blood creatinine,and analyze the factors affecting the occurrence of pruritus in MHD patients by Logitic regression analysis.Results:1.Of the 352 patients with MHD,161 had skin itching and the incidence rate was45.7%?161/352?.There was no significant difference between the two groups in dialysis age,dry weight,red blood cells,hemoglobin,platelets,blood sodium,blood potassium,and hematuria nitrogen?P<0.05?;The two groups had a statistically significant difference in age,blood phosphorus,blood calcium,blood creatinine,leptin,?₂-MG,iPTH,CRP,and Kt/v?P<0.05?.2.The results of the multi-factor Logitic regression analysis showed leptin?OR=2.543?,?₂-MG?OR=1.582?,iPTH?OR=7.665?,CRP?OR=1.26?,Kt/v?OR=1.137?and primary diabetes?OR=5.364?are factors that affect skin itching in MHD patients.Conclusion:1.There is a high incidence of skin itching in patients with MHD.Among them,leptin,?₂-MG,iPTH,CRP,Kt/v,and primary diabetes are the factors that affect skin itching in patients with MHD.Part two:Effects of different blood purification methods on skin itching in patients with MHD.Objective:Discuss different blood purification methods for MHD patients with skin itching provide scientific evidence for MHD patients to choose blood purification methods that are more conducive to improving the quality of life.Methods:Collection of patients with sustained hemodialysis with itchy skin during the period July 2016 to October 2016 at the Blood Purification Center of Henan University of Science and Technology,included in the criteria:age?18 years;Gender is not limited;Maintenance of hemodialysis time?3 months;Regular hemodialysis treatment,3 times per week,4 hours per time;Vascular access is not limited;iPTH?300pg/ml;There are itching symptoms of the skin;To be tested and sign an informed consent form.Exclusion criteria:Patients who are known to have allergic reactions to the materials of our hospital blood converters and blood burners,as well as patients who have blood irrigation to treat contraindications or intolerance;patients with blood flow<200ml/min;serum albumin<30g/L;iPTH>800pg/ml;KT/v<1.2;Patients who have been routinely treated with hemodialysis;Patients with other skin diseases,patients with other clotting disorders,patients with severe bleeding tendency,patients with active hemorrhage;In patients with low blood pressure and severe cardiopulmonary insufficiency,other clinical drug researchers have been conducted at this stage or recently?within 30 days?;Combined with acute infection,severe heart,lung,liver,nervous system diseases,such as acute,critical and malignant tumors.The study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Henan University of Science and Technology?see Appendix III?.According to the inclusion and exclusion criteria,a total of 100 patients were included,and basic data on selected patients were collected,including primary morbidity,dialysis age,age,and gender.All selected patients underwent an eight-week elution period,that is,they were treated with hemodialysis using German Fresenius FX8 dialysis for 8 weeks and dialysis 3 times a week for 4 hours each time.After 8 weeks of treatment,all patients were randomly grouped into four groups:regular hemodialysis group?HD?,high-throughput hemodialysis group?High-Flux hemodialysis group?,and routine hemodialysis+hemodialysis group?HFHD?.Hemodialysis+hemodialysis group?HD+HP?,high-throughput hemodialysis+hemodialysis+hemoperfusion group?HFHD+HP?.All subjects used the 4008B dialysis machine produced by Fresenius of Germany.The analyzer used a one-time low-throughput FX8 analyzer produced by Fresenius of Germany?membrane area 1.4 m²,ultrafiltration coefficient 12 mL/h/mmHg?.The one-time high-throughput FX60 analyzer?membrane area 1.4 m²,ultrafiltration coefficient46 mL/h/mmHg?,and the converter uses a one-time HA130 blood converter?material is cationic exchange resin?produced by Zhuhaijianfan.Dialytic blood flow in all subjects was set to be four times greater than or equal to a kilogram of body weight.Carbonate buffer was chosen as dialysis solution.Dialytic fluid flow was 500ml/min and dialysis time was 4 hours.The treatment methods of the four groups were 25 cases in the HD group.They were treated with a one-time FX8 hemodialysis device for 4hours each time and 3 dialysis sessions per week.25 patients in the HFHD group were treated with a disposable FX60 hemodialysis device for 4 hours each time and 3dialysis sessions per week;In the HD+HP group,25 cases were treated with a disposable HA130 blood infusion combined with a disposable FX8 hemodialysis device.After two hours,the irrigation was removed and continued for hemodialysis for two hours,1 time a week,and the remaining two were disposable.FX8 hemodialysis device dialysis treatment;In the HFHD+HP group,25 cases were treated with a disposable HA130 blood infusion combined with a FX60 hemodialysis machine for 2hours.The hemodialysis treatment continued for 2 hours,1 time a week,and the rest were performed with a disposable FX60 dialysis machine.Hemodialysis treatment,the Duo's improved itch score scale in the SF-36 scale was evaluated in four groups of patients before and after the first week of dialysis before and after treatment.SPSS20.0 statistical software was used for statistical analysis.The measured data was expressed by means of mean addition and subtraction standard deviation?`c±s?.and the multi-factor variance analysis with repeated measurements is used for different time points between multiple groups.The difference is statistically significant with P<0.05.There were no statistical differences in skin itching scores between groups 0,3,6 and 12.Results:1.Compared to the four groups,there is an interaction between time and group?F=43.684,P<0.001?,there are significant differences between different times?F=30.301,P<0.001?,there are significant differences between different groups?P<0.001?.In the 0th and 3th months,there was no statistically significant difference in skin itch score compared to hemodialysis group?P>0.05?In the 6th and12th months,compared with the hemodialysis group,the skin itch score was statistically significant;In HD+HP,HFHD+HP skin itch score decreased significantly over time.Conclusion:The score of skin pruritus in hemoperfusion group was significantly lower than that in hemodialysis group.Part three:Meta analysis of the efficacy of blood infusion in treating pruritus in patients with uremia.Objective:To evaluate the clinical efficacy of hemoperfusion?HP?in the treatment of pruritus in patients with uremia.Methods:Using a computer to retrieve and build a database in Chinese during the period from October 2018,China Zhinet Full Text Database?CNKI?,Wan Fang Medicine?Wan Fang?and Weipu Database;Foreign language database the Cochrane library,PublMed,Medline.The evaluation criteria for the efficacy of skin itching meet the recognized criteria for the evaluation of efficacy.The VAS,Dirk R Kuypers scores and other laboratory test indicators are used,such as:iPTH,blood calcium,blood phosphorus,hypersensitive C reaction protein,KT/v and so on.The two researchers separately extracted the data from the incorporated literature and cross-checked it to ensure the consistency of the data.If the article data is incomplete,try to contact the author of the article and search for the original data as far as possible to ensure the authenticity of the article.,Selection of documents based on incorporation criteria and,in the event of disagreement,adjudication by third-party researchers.Meta analysis is performed using Review Manager 5.3 software for statistics.Results:A total of 6 randomized controlled studies were included in a total of 413 patients.Meta analysis showed that:irrigation group compared with dialysis group for uremia patients better skin itching treatment.Conclusion:Hemoperfusion can be more effective in treating pruritus in patients with uremia.