Wu Hon-Yen, Peng Yu-Sen, Chen Hung-Yuan, Tsai Wan-Chuan, Yang Ju-Yeh, Hsu Shih-Ping, Pai Mei-Fen, Lu Hui-Min, Chiang Ju-Fen, Ko Mei-Ju, Wen Su-Ying, Chiu Hsien-Ching
From the Department of Internal Medicine (H-YW, Y-SP, H-YC, W-CT, J-YY, S-PH, M-FP); Department of Nursing (H-ML, J-FC), Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Internal Medicine (H-YW, Y-SP, H-YC, J-YY, S-PH, M-FP); Department of Dermatology (M-JK, H-CC), National Taiwan University Hospital and College of Medicine; Institute of Epidemiology and Preventive Medicine, National Taiwan University (H-YW, W-CT); and Department of Dermatology (M-JK, S-YW), Taipei City Hospital, Taipei, Taiwan.
Medicine (Baltimore). 2016 Mar;95(9):e2935. doi: 10.1097/MD.0000000000002935.
Uremic pruritus is common and bothersome in patients receiving either peritoneal dialysis (PD) or hemodialysis (HD). To date, the preferred dialysis modality regarding the alleviation of uremic pruritus remains controversial. We conducted this cross-sectional study to compare the prevalence, intensity, and characteristics of uremic pruritus between PD and HD patients. Patients receiving maintenance dialysis at a referral medical center in Taiwan were recruited. Dialysis modality, patient demographic, clinical characteristics, and laboratory data were recorded. The intensity of uremic pruritus was measured using visual analogue scale (VAS) scores. Multivariate linear regression analysis was conducted to compare the severity of uremic pruritus between PD and HD patients. Generalized additive models were applied to detect nonlinear effects between pruritus intensity and continuous covariates. A total of 380 patients completed this study, with a mean age of 60.3 years and 49.2% being female. Uremic pruritus was presented in 24 (28.6%) of the 84 PD patients and 113 (38.2%) of the 296 HD patients (P = .12). The VAS score of pruritus intensity was significantly lower among the PD patients than the HD patients (1.32 ± 2.46 vs 2.26 ± 3.30, P = .04). Multivariate linear regression analysis showed that PD was an independent predictor for lower VAS scores of pruritus intensity compared with HD (β-value -0.88, 95% confidence interval -1.62 to -0.13). The use of active vitamin D was also an independent predictor for a lower intensity of uremic pruritus, whereas hyperphosphatemia and higher serum levels of triglyceride and aspartate transaminase were significantly associated with higher pruritus intensity. There was a trend toward a less affected body surface area of uremic pruritus in the PD patients than in the HD patients, but the difference did not reach statistical significance (P = .13).In conclusion, the severity of uremic pruritus was lower among PD patients than HD patients, and PD may provide better alleviation of pruritus symptoms. The result provides a valuable reference for clinicians and patients when choosing a dialysis modality.
尿毒症瘙痒在接受腹膜透析（PD）或血液透析（HD）的患者中很常见且令人困扰。迄今为止，关于缓解尿毒症瘙痒的首选透析方式仍存在争议。我们进行了这项横断面研究，以比较PD和HD患者中尿毒症瘙痒的患病率、强度和特征。招募了在台湾一家转诊医疗中心接受维持性透析的患者。记录透析方式、患者人口统计学、临床特征和实验室数据。使用视觉模拟量表（VAS）评分来测量尿毒症瘙痒的强度。进行多变量线性回归分析以比较PD和HD患者中尿毒症瘙痒的严重程度。应用广义相加模型来检测瘙痒强度与连续协变量之间的非线性效应。共有380名患者完成了这项研究，平均年龄为60.3岁，女性占49.2%。84名PD患者中有24名（28.6%）出现尿毒症瘙痒，296名HD患者中有113名（38.2%）出现尿毒症瘙痒（P = 0.12）。PD患者的瘙痒强度VAS评分显著低于HD患者（1.32±2.46 vs 2.26±3.30，P = 0.04）。多变量线性回归分析表明，与HD相比，PD是瘙痒强度VAS评分较低的独立预测因素（β值 -0.88，95%置信区间 -1.62至 -0.13）。使用活性维生素D也是尿毒症瘙痒强度较低的独立预测因素，而高磷血症以及较高的血清甘油三酯和天冬氨酸转氨酶水平与较高的瘙痒强度显著相关。PD患者尿毒症瘙痒的受影响体表面积有低于HD患者的趋势，但差异未达到统计学意义（P = 0.13）。总之，PD患者中尿毒症瘙痒的严重程度低于HD患者，并且PD可能能更好地缓解瘙痒症状。该结果为临床医生和患者选择透析方式提供了有价值的参考。
