Marcello Matteo, Marturano Davide, Ronco Claudio, Zanella Monica
Department of Nephrology, Dialysis and Trasplantation, San Bortolo Hospital, Vicenza, Italy.
International Renal Research Institute Vicenza, IRRIV, Vicenza, Italy.
Clin Kidney J. 2024 Aug 29;17(9):sfae266. doi: 10.1093/ckj/sfae266. eCollection 2024 Sep.
Chronic kidney disease-associated pruritus (CKD-aP) is a common complication in dialysis patients which is not fully addressed by pharmacological and dialytic therapy. The objective was to review the literature on the effects of extracorporeal blood purification modalities on CKD-aP. The population comprised patients aged ≥18 years on chronic dialysis. PubMed, Embase, and Medline were systematically searched until February 2024 for clinical studies comparing the effect of different dialysis modalities on pruritus intensity. Two reviewers extracted data independently. Risk of bias for randomized controlled trials (RCTs) was assessed using the Cochrane tool. Any extracorporeal blood purification therapy for the treatment of CKD-aP was included. Outcome was quantitative change in pruritus intensity on a validated itching scale. This review included eight RCTs examining five different dialysis modalities, three observational studies examining three dialysis modalities, and six prospective clinical trials assessing four dialysis modalities. These treatments included peritoneal dialysis, low-flux and high-flux dialysis, hemodiafiltration, expanded hemodialysis, hemadsorption, hemodiafiltration with endogenous reinfusion and dialysis with polymethylmethacrylate membrane. Risk of bias was high in most studies. The largest body of evidence was found for the efficacy of hemadsorption. Limitations of evidence included heterogeneity in diagnostic tools and treatment, risk of selection bias, small sample sizes and short follow-up durations that made it challenging to perform a robust systematic review and meta-analysis. Despite the high prevalence of pruritus among dialysis patients, current evidence for efficacy of standard dialytic treatment is weak. The only technique that appears to be effective is hemoadsorption alone or coupled with hemodialysis. More high-quality studies are needed to confirm the long-term benefits.
慢性肾脏病相关性瘙痒（CKD-aP）是透析患者常见的并发症，药物治疗和透析治疗均无法完全解决该问题。目的是综述体外血液净化方式对CKD-aP影响的文献。研究人群包括年龄≥18岁的慢性透析患者。系统检索了PubMed、Embase和Medline，直至2024年2月，以查找比较不同透析方式对瘙痒强度影响的临床研究。两名评价员独立提取数据。使用Cochrane工具评估随机对照试验（RCT）的偏倚风险。纳入任何用于治疗CKD-aP的体外血液净化疗法。结局指标为经过验证的瘙痒量表上瘙痒强度的定量变化。本综述纳入了八项检验五种不同透析方式的RCT、三项检验三种透析方式的观察性研究以及六项评估四种透析方式的前瞻性临床试验。这些治疗方法包括腹膜透析、低通量和高通量透析、血液透析滤过、延长血液透析、血液吸附、内源性再输注血液透析滤过以及聚甲基丙烯酸甲酯膜透析。大多数研究的偏倚风险较高。关于血液吸附疗效的证据最多。证据的局限性包括诊断工具和治疗方法的异质性、选择偏倚风险、样本量小以及随访时间短，这使得进行有力的系统评价和荟萃分析具有挑战性。尽管透析患者中瘙痒的患病率很高，但目前标准透析治疗疗效的证据不足。唯一似乎有效的技术是单独的血液吸附或与血液透析联合使用。需要更多高质量的研究来证实其长期益处。
