Akhyani Maryam, Ganji Mohammad-Reza, Samadi Nasrin, Khamesan Behnaz, Daneshpazhooh Maryam
Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran.
BMC Dermatol. 2005 Jun 24;5:7. doi: 10.1186/1471-5945-5-7.
Pruritus is one of the most bothersome symptoms in patients on maintenance hemodialysis (HD), however little progress is seen in our understanding of its pathogenesis. The aim of this study was to evaluate the frequency of pruritus in HD patients in Tehran, Iran, and to correlate its presence and intensity with relevant clinical and laboratory parameters.
One hundred sixty-seven patients on maintenance HD at three out-patient HD units were enrolled in the study. Itch intensity was scored as mild, moderate and severe. Some relevant clinical and laboratory parameters (age, sex, xerosis, presence of neuropathy, duration of dialysis, history of atopy and laboratory findings including hematocrit, creatinine, urea, calcium, phosphorus, parathyroid hormone [PTH] and alkaline phosphatase) were evaluated.
Pruritus was found in 41.9% of patients. The intensity of itching was mild, moderate and severe, in 51.4%, 11.4% and 37.7% of patients, respectively. In 22 patients (31.4%) pruritus intensified during and after dialysis. There was no significant difference in the serum levels of creatinine, blood urea nitrogen, calcium, phosphorus, alkaline phosphatase, PTH and hematocrit between patients with and without pruritus. Age, sex, xerosis, underlying renal disease, history of atopy and duration of haemodialysis were not significantly different between the two groups. However, neuropathy was significantly more common in the pruritic group (63.8% versus 42.1%) (pv = 0.006).
Clinical neuropathy was the only significant finding in the pruritic group in our study. This finding justifies further research on nerve function and neurotransmitters in hemodialysis patients and the introduction of new drugs targeting neuropathy.
瘙痒是维持性血液透析（HD）患者最困扰的症状之一，然而我们对其发病机制的了解进展甚微。本研究的目的是评估伊朗德黑兰HD患者瘙痒的发生率，并将其存在情况和严重程度与相关临床及实验室参数进行关联。
本研究纳入了三个门诊HD单位的167例维持性HD患者。瘙痒强度分为轻度、中度和重度。评估了一些相关临床及实验室参数（年龄、性别、皮肤干燥、神经病变的存在、透析时间、特应性病史以及包括血细胞比容、肌酐、尿素、钙、磷、甲状旁腺激素[PTH]和碱性磷酸酶在内的实验室检查结果）。
41.9%的患者存在瘙痒。瘙痒强度为轻度、中度和重度的患者分别占51.4%、11.4%和37.7%。22例患者（31.4%）在透析期间及透析后瘙痒加剧。有瘙痒和无瘙痒患者的血清肌酐、血尿素氮、钙、磷、碱性磷酸酶、PTH和血细胞比容水平无显著差异。两组患者的年龄、性别、皮肤干燥、潜在肾脏疾病、特应性病史和血液透析时间无显著差异。然而，瘙痒组神经病变明显更常见（63.8%对42.1%）（pv = 0.006）。
临床神经病变是我们研究中瘙痒组唯一的显著发现。这一发现证明有必要进一步研究血液透析患者的神经功能和神经递质，并引入针对神经病变的新药。
