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      Factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis in Lima, Peru

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          Abstract

          The objective of the study is to analyze the factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis.

          The methodology used is based on a cross-sectional study in patients receiving hemodialysis at the Centro Nacional de Salud Renal. Severe pruritus was defined as a score on the visual analogue scale greater than or equal to 7, and the strength of association with the possible risk factors was assessed by calculating prevalence ratios. Regarding the results, 264 patients were included, 59.9% were male, with a mean time on hemodialysis of 10.26 ± 7.14 years. 75% experienced pruritus, of this group, 1 in 3 presented severe pruritus. Hyperphosphatemia and the use of antihistamines were associated with a higher prevalence of severe pruritus (RP 1.71, 95% CI 1.09-267 and RP 2.39, 95% CI 1.51-3.75, respectively). The positive serology for Hepatitis C Virus was described as a protective factor for presenting severe pruritus (RP 0.55, 95% CI 0.33-0.89). In conclusion, severe uremic pruritus is a frequent problem in patients with chronic terminal kidney disease who have hyperphosphatemia and treatment with antihistamines independently of the time they have been on hemodialysis.

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          Visual analogue scale: evaluation of the instrument for the assessment of pruritus.

          Adam Reich, Monika Heisig, Ngoc Quan Phan … (2012)
          The aim of this study was to evaluate the visual analogue scale (VAS) as a method of pruritus assessment. A total of 310 subjects with pruritic dermatoses (148 Caucasian subjects and 162 Asian subjects) were recruited. The patients assessed pruritus intensity using the horizontal and vertical VAS, numeric rating scale (NRS) and verbal rating scale (VRS). All scales showed very good reproducibility (intraclass coefficient (ICC) > 0.8). No significant differences were found between the horizontal and vertical VAS (5.3 ± 2.9 vs. 5.3 ± 3.0 points, p = 0.34). Using NRS, patients rated their pruritus significantly higher than with VAS (5.7 ± 2.6 points, p 0-< 4 points = mild pruritus, ≥ 4-< 7 points = moderate pruritus, ≥ 7-< 9 points = severe pruritus, and ≥ 9 points = very severe pruritus. In conclusion, the VAS is a valuable method of pruritus measurement.
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            Itch.

            Andrew Greaves, Martin Schmelz, Gil Yosipovitch (2003)
            Itch is a common skin sensation, with substantial effects on behaviour. Neurophysiological research has permitted accurate definition of neural pathways of itch, and has confirmed the distinctiveness of itch pathways in comparison with pain. A clinical classification of itch, based on such improved understanding, describes the difference between peripheral (pruritoceptive) and central (neurogenic or neuropathic) itch. New specific and sensitive investigational methods in people and animals enable us to better understand this bothersome symptom, and have important clinical implications. We describe the clinical classification of itch, new findings on neuropathophysiology of itch, methods for assessment, and improved treatments.
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              How can we achieve global equity in provision of renal replacement therapy?

              Terra White, Alan Cass, Stephen Jan … (2008)
              There is a significant emerging burden of chronic and end-stage kidney disease in low- and middle-income countries, driven by population ageing and the global epidemic of type 2 diabetes. Sufferers of end-stage kidney disease require ongoing dialysis or kidney transplantation to survive; however, in many low- and middle-income countries, treatment options are strictly limited or unaffordable. Low numbers of maintenance dialysis patients and transplant recipients reflect profound economic and service provision challenges for health-care systems in low- and middle-income countries in sustaining renal replacement therapy programmes. Underdeveloped organ donor and transplant programmes, health system and financing issues, ethical regulation of transplantation and the cost of pharmaceuticals commonly pose additional barriers to the delivery of efficient and cost-effective renal replacement therapy. Development of locally appropriate transplant programmes, effective use of nongovernmental sources of funding, service planning and cost containment, use of generic drugs and local manufacture of dialysis consumables have the potential to make life-saving renal replacement therapy available to many more in need. Select low- and middle-income countries demonstrate more equitable provision of renal replacement therapy is possible outside high-income countries. For other low- and middle-income countries, education, the development of good public policy and a supportive international environment are critical. Prevention of end-stage kidney disease, ideally as part of an integrated approach to chronic vascular diseases, must also be a key objective.
              Article 0 comments Cited 60 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Dermatol Reports
                Journal ID (publisher-id): DR
                Title: Dermatology Reports
                Publisher: PAGEPress Publications, Pavia, Italy
                ISSN (Print): 2036-7392
                ISSN (Electronic): 2036-7406
                Publication date (Electronic): 23 June 2020
                Publication date Collection: 25 June 2020
                Volume: 12
                Issue: 1
                Electronic Location Identifier: 8310
                Affiliations
                [1 ]Dermatologist, Universidad Nacional Mayor de San Marcos
                [2 ]Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas (UPC)
                [3 ]Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas (UPC)
                [4 ]Facultad de Ciencias de la Salud, Universidad Tecnológica del Perú , Lima, Peru
                Author notes
                Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias (UPC), Av. Primavera 2390-Monterrico, Lima, Peru. +51 1992154452 - +51 0 1 2470111 gian_will@ 123456hotmail.com

                Conflict of interest: The authors declare no potential conflict of interests.

                Ethical approval: The study was approved by the Ethics Committee of the Hospital Nacional Edgardo Rebagliati Martins and by the Research Committee of the Centro Nacional de Salud Renal (CNSR).

                Article
                DOI: 10.4081/dr.2020.8310
                PMC ID: 7341070
                SO-VID: 38b4031b-de6f-430c-acff-3389f8d0a9a6
                Copyright © ©Copyright: the Author(s)
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 September 2019
                Date accepted : 25 May 2020
                Page count
                Figures: 0, Tables: 4, Equations: 0, References: 23, Pages: 4
                Categories
                Subject: Article

                Keywords: pruritus,dialysis,chronic renal failure
                Data availability:
                Keywords: pruritus, dialysis, chronic renal failure

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