Department of Nephrology, Erciyes Medical Faculty, Kayseri, Turkey.
Department of Dermatology, Erciyes Medical Faculty, Kayseri, Turkey.
Int Urol Nephrol. 2022 Mar;54(3):619-625. doi: 10.1007/s11255-021-02929-0. Epub 2021 Jul 2.
Several factors play a role in the pathogenesis of pruritus in uremic patients. The pathophysiology is complex and many factors have been identified in these patients. The aim of this study was to investigate the presence, severity, and possible causes of pruritus in patients with peritoneal dialysis (PD) .
Eighty patients, who received continuous ambulatory peritoneal dialysis (CAPD) treatment, were included in this study. Biochemical measurements, parathormone, C-reactive protein (CRP), and vitamin B12 levels of all the patients were recorded. Furthermore, substance P (SP) levels were measured by ELISA methods. Patients were examined by a dermatologist and pruritus degrees were queried using the visual analog score (VAS) with skin dryness.
In generalized linear model analysis, total urea clearance and SP independently predicted VAS scores. SP was significantly predictive in ROC analysis in identifying the VAS score in patients with peritoneal dialysis. The sensitivity and specificity of SP were 80% and 67% (cut-off > 364), respectively, with an area under the ROC curve of 0.757 (95% CI 0.650-0.865, p < 0.001). SP also was significantly predictive in ROC analysis in identifying xerosis in PD patients.
Pruritus was proportional to the amount of substance P and total urea clearance was another reason affecting pruritus in peritoneal dialysis patients.
多种因素在尿毒症患者瘙痒的发病机制中起作用。其病理生理学较为复杂，在这些患者中已发现许多因素。本研究的目的是调查腹膜透析（PD）患者瘙痒的存在、严重程度和可能原因。
本研究纳入了 80 名接受持续不卧床腹膜透析（CAPD）治疗的患者。记录所有患者的生化测量值、甲状旁腺激素、C 反应蛋白（CRP）和维生素 B12 水平。此外，通过 ELISA 方法测量 P 物质（SP）水平。由皮肤科医生对患者进行检查，并使用视觉模拟评分（VAS）和皮肤干燥度来询问瘙痒程度。
在广义线性模型分析中，总尿素清除率和 SP 独立预测了 VAS 评分。SP 在 ROC 分析中对识别腹膜透析患者的 VAS 评分具有显著预测性。SP 的灵敏度和特异性分别为 80%和 67%（截断值>364），ROC 曲线下面积为 0.757（95%CI 0.650-0.865，p<0.001）。SP 在 ROC 分析中对识别 PD 患者的干燥症也具有显著预测性。
瘙痒与 P 物质的含量成正比，总尿素清除率是另一个影响腹膜透析患者瘙痒的原因。
