Kidney Disease Clinic of Nippon Medical School, Bunkyo-ku, Japan.
Department of Nephrology, Koyama Memorial Hospital, Kashima, Japan.
J Dermatol. 2021 Sep;48(9):1327-1335. doi: 10.1111/1346-8138.15950. Epub 2021 May 26.
Xerosis and pruritus are common in patients undergoing dialysis. These symptoms are treated with moisturizers, but limited evidence supports the efficacy of such treatment. Our exploratory study suggested the effectiveness of a heparinoid-containing product for xerosis in dialysis patients. We conducted a multicenter, open-label, randomized, before-after, parallel-group comparative study to verify the exploratory study results (Clinical Trial Registry: UMIN000029360). Seventy-one Japanese patients undergoing dialysis with chronic kidney disease and xerosis were randomly assigned to receive a heparinoid-containing product for 2 weeks (group A [n = 36]) or 8 weeks (group B [n = 35]). Patients were instructed to apply the study product based on the fingertip unit method. The efficacy endpoints were the water content of the stratum corneum (WCSC), skin dryness score, pruritus visual analog scale score, and Dermatology Life Quality Index. Safety was assessed by monitoring adverse events. The mean WCSC (arbitrary units) was 26.0 ± 9.6 in group A and 25.2 ± 10.0 in group B at the start of treatment (week 0), significantly increased to 39.0±12.5 in group A and 38.5 ± 11.0 in group B (P < 0.0001 for both vs week 0) by week 2, and then decreased only in group A. Thus, the WCSC at week 4 (the primary endpoint) remained significantly higher in group B (36.4 ± 12.2 vs 28.8 ± 10.4; P = 0.0068). Other endpoints improved during treatment with the study product. One patient developed a rash and erythema as treatment-related adverse events. In conclusion, 8 weeks' application of a heparinoid-containing product was effective for xerosis in patients undergoing dialysis.
干燥和瘙痒在透析患者中很常见。这些症状可以通过保湿剂治疗,但有限的证据支持这种治疗的疗效。我们的探索性研究表明,肝素类产品对透析患者的干燥症有效。我们进行了一项多中心、开放标签、随机、前后对照、平行组比较研究,以验证探索性研究结果(临床试验注册:UMIN000029360)。71 名患有慢性肾脏病和干燥症的接受透析的日本患者被随机分配接受肝素类产品治疗 2 周(A 组 [n=36])或 8 周(B 组 [n=35])。患者被指示根据指尖单位法使用研究产品。疗效终点为角质层水分含量(WCSC)、皮肤干燥评分、瘙痒视觉模拟评分和皮肤病生活质量指数。通过监测不良事件评估安全性。治疗开始时(第 0 周),A 组的平均 WCSC(任意单位)为 26.0±9.6,B 组为 25.2±10.0,第 2 周时显著增加至 A 组的 39.0±12.5 和 B 组的 38.5±11.0(与第 0 周相比,均 P<0.0001),然后仅在 A 组下降。因此,第 4 周(主要终点)的 WCSC 在 B 组仍显著较高(36.4±12.2 与 28.8±10.4;P=0.0068)。其他终点在使用研究产品治疗期间有所改善。1 名患者出现皮疹和红斑等治疗相关不良事件。总之,肝素类产品应用 8 周对透析患者的干燥症有效。