Duque M I, Thevarajah S, Chan Y H, Tuttle A B, Freedman B I, Yosipovitch G
Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Clin Nephrol. 2006 Sep;66(3):184-91. doi: 10.5414/cnp66184.
The prevalence and characteristics of uremic pruritus have not recently been investigated in a US dialysis cohort. This study examined uremic pruritus and associated risk factors in hemodialysis patients treated in the year 2005.
The prevalence and characteristics of pruritus (short version McGill pain questionnaire), severity (10 cm visual analogue scale), and effect on quality of life (Skindex-16) were determined in thrice weekly hemodialysis patients. Daugirdas single-pool Kt/V, clinical and laboratory data were recorded.
105 of 307 screened hemodialysis patients met inclusion criteria and were evaluated, 49% (151) were excluded due to advanced age, 3% (9) other skin diseases, and 14% (42) refused. Participants were 55% male (58/105) and 65% African-American (68) with a mean +/- SD age of 48 +/- 11 years. The overall prevalence of pruritus was 57% (60/105, 95% CI 47 - 67%) and a positive correlation was observed between the presence of uremic itch and serum calcium concentration (p = 0.04). Intact PTH and serum phosphorus concentration were not associated with either the presence or intensity of itch. Intensity of pruritus was positively correlated with increasing months on dialysis (64 +/- 63 vs. 51 +/- 46 months for itch and non-itch, respectively; p = 0.02), higher Kt/V (1.82 +/- 0.7 vs. 1.70 +/- 0.56 for itch and non-itch, respectively; p = 0.01) and skin dryness (p = 0.01). Patients receiving statins were significantly less likely to report pruritus (p = 0.02) and uremic itch adversely impacted several aspects of quality of life.
Pruritus remains a common and significant symptom in adequately hemodialyzed patients. Higher serum calcium concentrations, longer durations of ESRD and higher Kt/V appear to be important factors associated with uremic pruritus.
美国透析队列中近期未对尿毒症瘙痒的患病率及特征进行研究。本研究调查了2005年接受治疗的血液透析患者的尿毒症瘙痒及相关危险因素。
对每周进行三次血液透析的患者，测定瘙痒的患病率及特征（简短版麦吉尔疼痛问卷）、严重程度（10厘米视觉模拟量表）以及对生活质量的影响（Skindex - 16）。记录Daugirdas单池Kt/V、临床和实验室数据。
307名接受筛查的血液透析患者中，105名符合纳入标准并接受评估，49%（151名）因年龄较大被排除，3%（9名）因其他皮肤病被排除，14%（42名）拒绝参与。参与者中55%为男性（58/105），65%为非裔美国人（68名），平均年龄±标准差为48±11岁。瘙痒的总体患病率为57%（60/105，95%置信区间47 - 67%），尿毒症瘙痒的存在与血清钙浓度之间存在正相关（p = 0.04）。完整的甲状旁腺激素和血清磷浓度与瘙痒的存在或强度均无关。瘙痒强度与透析月数增加呈正相关（瘙痒组和无瘙痒组分别为64±63个月和51±46个月；p = 0.02），与较高的Kt/V呈正相关（瘙痒组和无瘙痒组分别为1.82±0.7和1.70±0.56；p = 0.01）以及与皮肤干燥呈正相关（p = 0.01）。接受他汀类药物治疗的患者报告瘙痒的可能性显著降低（p = 0.02），尿毒症瘙痒对生活质量的多个方面产生不利影响。
瘙痒仍是充分血液透析患者中常见且显著的症状。较高的血清钙浓度、较长的终末期肾病病程和较高的Kt/V似乎是与尿毒症瘙痒相关的重要因素。
