Shah Aparna, Hada Rajani, Kayastha Bhasker Mahan Mehar
Department of Dermatology, Shree Birendra Hospital, Kathmandu, Nepal.
Department of Nephrology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2013 Apr-Jun;52(190):365-71.
Dermatological disorders are common complications of CKD affecting all most all patients. Present study aimed to evaluate these disorders in CKD with and without Maintenance Hemodialysis and their association with age, sex, severity and duration of CKD and dialysis.
It is a cross-sectional comparative study. Eighty-three patients with established CKD, without MHD (n=35) and with MHD (n= 48), were examined for dermatological disorders.
The mean age of patients were 46±15.6 years with male to female ratio of 1.18:1. Among CKD without MHD, six patients were in stage 4 and 29 patients were in stage 5 with estimated GFR (24.4±3.9 and 5.6±2.9) ml/1.73m2/min respectively by MDRD equation. CKD without and with MHD had similar age, sex, blood urea, hemoglobin. Dermatological disorders were found in 100% CKD patients with pallor 76 (91.5%), xerosis 63 (75.9%), pigmentary changes 54 (65%), pruritus 50 (60.2%), skin infection 40 (48.2%), vascular changes 14 (16.8%), mucosal changes 56 (67.5%), hair changes 49 (59%), non -specific nail changes 68 (81.9%) and specific nail changes 12 (14.4%). Specific 8 (22.8%) vs 4 (8.3%), p<0.03 and non- specific 32 (91.4%) vs 36 (75%), p<0.05 nail changes and hair abnormalities 26 (74.3%) vs. 23 (47.9%), p<0.01 were significantly lower in MHD patients.
Dermatological disorders were present in all CKD patients with significantly lower nail and hair changes in MHD. A further longitudinal study is necessary to find out pathophysiology and effect of treatment in these disorders.
皮肤病是慢性肾脏病(CKD)常见的并发症,几乎影响所有患者。本研究旨在评估接受和未接受维持性血液透析的CKD患者中的这些皮肤病及其与年龄、性别、CKD严重程度和病程以及透析的相关性。
这是一项横断面比较研究。对83例确诊的CKD患者进行了皮肤病检查,其中未接受维持性血液透析(MHD)的患者35例,接受MHD的患者48例。
患者的平均年龄为46±15.6岁,男女比例为1.18:1。在未接受MHD的CKD患者中,6例处于4期,29例处于5期,根据MDRD方程估算的肾小球滤过率(GFR)分别为(24.4±3.9)和(5.6±2.9)ml/1.73m²/min。未接受和接受MHD的CKD患者在年龄、性别、血尿素、血红蛋白方面相似。在所有CKD患者中均发现有皮肤病,面色苍白76例(91.5%)、皮肤干燥63例(75.9%)、色素沉着改变54例(65%)、瘙痒50例(60.2%)、皮肤感染40例(48.2%)、血管改变14例(16.8%)、黏膜改变56例(67.5%)、毛发改变49例(59%)、非特异性指甲改变68例(81.9%)以及特异性指甲改变12例(14.4%)。特异性指甲改变在MHD患者中为8例(22.8%)对比4例(8.3%),p<0.03;非特异性指甲改变为32例(91.4%)对比36例(75%),p<0.05;毛发异常为26例(74.3%)对比23例(47.9%),p<0.01,MHD患者中的发生率显著更低。
所有CKD患者均存在皮肤病,MHD患者的指甲和毛发改变明显更少。有必要进行进一步的纵向研究以明确这些疾病的病理生理学及治疗效果。