Department of Dermatology, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan.
PLoS One. 2013 Aug 6;8(8):e71404. doi: 10.1371/journal.pone.0071404. Print 2013.
Uremic pruritus is a common and intractable symptom in patients on chronic hemodialysis, but factors associated with the severity of pruritus remain unclear. This study aimed to explore the associations of metabolic factors and dialysis adequacy with the aggravation of pruritus.
We conducted a 5-year prospective cohort study on patients with maintenance hemodialysis. A visual analogue scale (VAS) was used to assess the intensity of pruritus. Patient demographic and clinical characteristics, laboratory parameters, dialysis adequacy (assessed by Kt/V), and pruritus intensity were recorded at baseline and follow-up. Change score analysis of the difference score of VAS between baseline and follow-up was performed using multiple linear regression models. The optimal threshold of Kt/V, which is associated with the aggravation of uremic pruritus, was determined by generalized additive models and receiver operating characteristic analysis.
A total of 111 patients completed the study. Linear regression analysis showed that lower Kt/V and use of low-flux dialyzer were significantly associated with the aggravation of pruritus after adjusting for the baseline pruritus intensity and a variety of confounding factors. The optimal threshold value of Kt/V for pruritus was 1.5 suggested by both generalized additive models and receiver operating characteristic analysis.
Hemodialysis with the target of Kt/V ≥1.5 and use of high-flux dialyzer may reduce the intensity of pruritus in patients on chronic hemodialysis. Further clinical trials are required to determine the optimal dialysis dose and regimen for uremic pruritus.
尿毒症瘙痒是慢性血液透析患者常见且难以治疗的症状，但与瘙痒严重程度相关的因素仍不清楚。本研究旨在探讨代谢因素和透析充分性与瘙痒加重的关系。
我们对维持性血液透析患者进行了一项为期 5 年的前瞻性队列研究。采用视觉模拟评分（VAS）评估瘙痒强度。记录患者的人口统计学和临床特征、实验室参数、透析充分性（用 Kt/V 评估）和瘙痒强度，在基线和随访时进行评估。采用多元线性回归模型对基线和随访时 VAS 差值评分的变化分数进行分析。采用广义加性模型和受试者工作特征分析确定与尿毒症瘙痒加重相关的最佳 Kt/V 阈值。
共有 111 名患者完成了研究。线性回归分析表明，在调整基线瘙痒强度和多种混杂因素后，较低的 Kt/V 和使用低通量透析器与瘙痒加重显著相关。广义加性模型和受试者工作特征分析均提示，Kt/V 治疗瘙痒的最佳阈值为 1.5。
以 Kt/V≥1.5 为目标的血液透析和使用高通量透析器可能会降低慢性血液透析患者的瘙痒强度。需要进一步的临床试验来确定治疗尿毒症瘙痒的最佳透析剂量和方案。
