Department of Clinical Social Medicine, Occupational and Environmental Dermatology, Ruprecht Karls University, University Hospital Heidelberg, Heidelberg, Germany.
Department of Nephrology, DKD Helios Clinic, Wiesbaden, Germany.
J Eur Acad Dermatol Venereol. 2019 Jul;33(7):1429-1435. doi: 10.1111/jdv.15483. Epub 2019 Mar 5.
Chronic itch (CI) is a frequent symptom in hemodialysis (HD) patients. Previous studies demonstrated great impairments of general well-being and health-related quality of life (HRQOL) as well as a higher mortality in those suffering from CI.
The German Epidemiological Hemodialysis Itch Study (GEHIS) is a representative cohort of HD patients in Germany. All patients were followed up 4 years later. The current analyses present data on the course of CI in HD patients, its associated factors including comorbidities, laboratory values and HRQOL.
We assessed sociodemographic data, routine laboratory values, comorbidities, HRQOL (SF-12), depression and anxiety (HADS), sleep (duration and quality) and in those suffering from CI characteristics, intensity of CI and itch-related quality of life (ItchyQoL). Those with CI were offered a dermatological examination and CI was classified according to the IFSI classification. Patients were asked if they had consulted a physician about CI.
Of the patients who had suffered from CI in 2013 (n = 234), 90.5% (212) patients could be followed up. About 36.3% (n = 85) had died, 9.8% (n = 23) had received a kidney transplant in the meantime. A total of 52 HD patients still suffered from CI, in 52 CI had stopped. Those patients still suffering from CI (n = 52) reported a higher mean itch intensity, lower ItchyQoL, higher levels of anxiety and a lower mean sleeping time in 2013. On the other hand, those who did not suffer from CI anymore showed a significant increase of HRQOL compared to 2013. There was no significant difference in dialysis characteristics and laboratory values except for albumin. Only a minority of patients in HD had consulted a dermatologist because of CI (29.9%).
Our data demonstrate that CI is a persisting symptom in 50% of the HD patients and when it disappears HRQOL recovers. We confirm that CI is a disregarded symptom in HD patients.
慢性瘙痒（CI）是血液透析（HD）患者常见的症状。先前的研究表明，患有 CI 的患者普遍存在身心健康受损以及生活质量（HRQOL）下降的问题，并且死亡率更高。
德国流行病学血液透析瘙痒研究（GEHIS）是一项具有代表性的德国 HD 患者队列研究。所有患者在 4 年后接受随访。目前的分析提供了 HD 患者 CI 病程的数据，以及包括合并症、实验室值和 HRQOL 在内的相关因素。
我们评估了社会人口统计学数据、常规实验室值、合并症、HRQOL（SF-12）、抑郁和焦虑（HADS）、睡眠（时长和质量），以及患有 CI 的患者的瘙痒特征、CI 强度和瘙痒相关生活质量（ItchyQoL）。对患有 CI 的患者进行皮肤科检查，并根据 IFSI 分类对 CI 进行分类。患者被询问是否因 CI 咨询过医生。
在 2013 年患有 CI 的患者中（n=234），有 90.5%（n=212）患者可进行随访。约 36.3%（n=85）已经死亡，9.8%（n=23）在此期间接受了肾移植。共有 52 名 HD 患者仍患有 CI，52 名 CI 已停止。2013 年仍患有 CI 的患者（n=52）报告的平均瘙痒强度更高，ItchyQoL 更低，焦虑水平更高，睡眠时间更短。另一方面，那些不再患有 CI 的患者与 2013 年相比，HRQOL 显著提高。除白蛋白外，透析特征和实验室值没有显著差异。由于 CI，只有少数 HD 患者（29.9%）咨询过皮肤科医生。
我们的数据表明，CI 是 50%HD 患者持续存在的症状，当 CI 消失时，HRQOL 会恢复。我们证实 CI 是 HD 患者被忽视的症状。
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