Characteristics of uremic pruritus in hemodialysis patients: data from a single center

Abstract Background Hyperphosphatemia is a common complication in patients on maintenance hemodialysis. Patients’ adherence to phosphorus control can be improved by consistent education. However, few studies have focused on the model construction and effects of health education on phosphate control for hemodialysis patients. Objective To develop an intensive education program focusing on phosphate control among hemodialysis patients and to analyze the effectiveness of this program. Design A non-randomized, single-arm, single-center trial lasting for 6 months. Setting This program was conducted in a hemodialysis center in a teaching hospital in Zhuhai, China. Participants Patients on maintenance hemodialysis with hyperphosphatemia. Methods An intensive hyperphosphatemia control education program lasting for 6 months was conducted among 366 hemodialysis patients applying the First Principles of Instruction model, which focused on mastering four stages: (a) activation of prior experience, (b) demonstration of skills, (c) application of skills and (d) integration of these skills into real-world activities. The controlled percentage of serum phosphorus, knowledge of hyperphosphatemia, and adherence to phosphate binders before and after the education program were assessed. Results The proportion of controlled serum phosphorus was significantly increased from 43.5 to 54.9% (P<0.001). The scores on the knowledge of phosphate control were improved significantly from 59.0 ± 18.9 to 80.6 ± 12.4 (P < 0.001). The proportion of high adherence to phosphate binders was increased dramatically from 21.9 to 44.5% (P < 0.001). Conclusion The intensive education program can effectively improve serum phosphorus, knowledge of hyperphosphatemia, and adherence to phosphate binders among hemodialysis patients. Trial registration Chinese Clinical Trial Registry, ChiCTR2100042017. Retrospectively registered January 12th, 2021.

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The correlation between uremic pruritus and blood lead levels in prevalent hemodialysis patients and its relation to the severity of pruritus using visual analog score

The Egyptian Journal of Internal Medicine ◽

10.1186/s43162-021-00045-0 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Sahar Mahmoud Shawky ◽

Reeham Abdel Aziz Abdel Hamid ◽

Lina Essam Khedr

Keyword(s):

Blood Lead ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Visual Analog Score ◽

Blood Lead Levels ◽

Cross Sectional ◽

Uremic Pruritus ◽

Significant Difference ◽

Lead Levels ◽

Group 2

Abstract Background Pruritus is a common and often distressing symptom in patients with chronic kidney disease. Though the pathogenesis of uremic pruritus remains poorly understood, systemic inflammation has presented itself as one of the possible explanations. High blood lead levels (BLLs) have been noted to be associated with inflammation and poor nutritional status in hemodialysis patients. Our aim is to study the relation between blood lead levels and uremic pruritus. This is a cross-sectional study that enrolled 50 patients; all were on regular hemodialysis 3 times per week for at least 6 months. Patients were divided into 2 groups, group 1 (n =10) with no pruritus and group 2 (n=40) with varying degrees of pruritus. Group 2 was further divided according to intensity of pruritus by visual analog score (VAS) into mild (n=10), moderate (n=20), and severe pruritus (n=10). Results There was a significant difference in serum lead levels and ferritin levels between groups 1 and 2 (p value < 0.01 and < 0.05, respectively). There was a statistically significant difference in serum lead levels in the groups with varying intensity of pruritus, having higher serum lead levels in patients who exhibited severe pruritus (p value < 0.005) Moreover, a statistically significant relation between elevated blood lead levels and the duration of dialysis was observed in this study. Conclusion Uremic pruritus is a multi-factorial phenomenon, and our study showed that blood lead levels in hemodialysis patients might be associated with increased intensity of pruritus.

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COVID-19 in hemodialysis patients: a single-center experience in Istanbul

International Urology and Nephrology ◽

10.1007/s11255-021-02823-9 ◽

2021 ◽

Author(s):

Sibel Yucel Kocak ◽

Arzu Ozdemir Kayalar ◽

Hayat Kumbasar Karaosmanoglu ◽

Murvet Yilmaz

Keyword(s):

Hemodialysis Patients ◽

Single Center ◽

Single Center Experience

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Single Center Experience of Tunneled Jugular Catheter Placement After Sharp Recanalization in Four Hemodialysis Patients With Central Venous Occlusion Awaiting Renal Transplant

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2016.03.279 ◽

2016 ◽

Vol 67 (5) ◽

pp. A86

Keyword(s):

Renal Transplant ◽

Venous Occlusion ◽

Hemodialysis Patients ◽

Catheter Placement ◽

Single Center ◽

Central Venous ◽

Single Center Experience ◽

Sharp Recanalization ◽

Central Venous Occlusion

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Impact of transvenous cardiac implantable electronic devices in chronic hemodialysis patients: a single-center, observational comparative study

BMC Nephrology ◽

10.1186/s12882-018-1095-y ◽

2018 ◽

Vol 19 (1) ◽

Author(s):

Seonjeong Jeong ◽

Gi Byoung Nam ◽

Jai Won Chang ◽

Min-Ju Kim ◽

Youngjin Han ◽

...

Keyword(s):

Comparative Study ◽

Electronic Devices ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Single Center ◽

Cardiac Implantable Electronic Devices

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A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of Nalbuphine ER Tablets for Uremic Pruritus

American Journal of Nephrology ◽

10.1159/000484573 ◽

2017 ◽

Vol 46 (6) ◽

pp. 450-458 ◽

Cited By ~ 29

Author(s):

Vandana S. Mathur ◽

Jayant Kumar ◽

Paul W. Crawford ◽

Howard Hait ◽

Thomas Sciascia ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Controlled Trial ◽

Hemodialysis Patients ◽

Opioid Antagonist ◽

Opioid Agonist ◽

Double Blind ◽

Double Blind Placebo ◽

Uremic Pruritus ◽

The Mean

Background: Pruritus is a distressing hallmark of the uremic condition, affecting approximately 60% of hemodialysis patients. Abnormal endogenous opioid ligand activity at μ and κ-opioid receptors has been postulated as a mechanism in uremic pruritus. Nalbuphine is a μ-opioid antagonist and κ-opioid agonist. Methods: In this multicenter, randomized, double-blind, placebo-controlled trial, 373 hemodialysis patients with moderate or severe uremic pruritus were randomized in a 1: 1:1 ratio to nalbuphine extended-release tablets 120 mg (NAL 120), 60 mg (NAL 60), or placebo and treated for 8 weeks. Three hundred seventy-one were analyzed for efficacy. The primary endpoint was the change from baseline to treatment weeks 7 and 8 in itching intensity on a Numerical Rating Scale (NRS, 0 [no itching]; 10 [worst possible itching]) using an intent-to-treat approach. The aim was to evaluate the safety and antipruritic efficacy of NAL. Results: The mean duration of itching was 3.2 years. From a baseline NRS of 6.9 (1.5), the mean NRS declined by 3.5 (2.4) and by 2.8 (2.2) in NAL 120 mg and the placebo groups, respectively (p = 0.017). There was no evidence of tolerance. A trend for less sleep disruption due to itching (p = 0.062, NAL 120 vs. placebo) was also observed. There were no significant differences between NAL 60 vs. placebo. Serious adverse events occurred in 6.7, 12.7, and 15.4% in the NAL 120, NAL 60, and placebo groups respectively. Conclusions: In this largest-to-date randomized controlled trial in uremic pruritus, NAL 120 durably and significantly reduced the itching intensity among hemodialysis patients.

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Uremic Pruritus Is Not Associated with Endocannabinoid Receptor 1 Gene Polymorphisms

BioMed Research International ◽

10.1155/2016/3567527 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Monika Heisig ◽

Łukasz Łaczmański ◽

Adam Reich ◽

Felicja Lwow ◽

Jacek C. Szepietowski

Keyword(s):

Specific Treatment ◽

Endocannabinoid System ◽

Hemodialysis Patients ◽

Control Group ◽

Chain Reactions ◽

Uremic Pruritus ◽

Patients With Diabetes ◽

Bothersome Symptom ◽

Endocannabinoid Receptor ◽

Cnr1 Gene

Uremic pruritus (UP) is a frequent and bothersome symptom in hemodialysis patients. Its etiology is not fully understood and that is why there is no specific treatment. The endocannabinoid system plays a role in many pathological conditions. There is reliable evidence on the association between cannabinoid system and pruritus. In our study, we aimed to evaluate whether genetic variations in the endocannabinoid receptor 1 (CNR1) gene can affect UP. The rs12720071, rs806368, rs1049353, rs806381, rs10485170, rs6454674, and rs2023239 polymorphisms of the CNR1 gene were genotyped in 159 hemodialysis patients and 150 healthy controls using two multiplex polymerase chain reactions and the minisequencing technique. No statistically significant relationship was found in any of the evaluated genotypes between patients with and without UP, even after excluding patients with diabetes and dyslipidemia. There were no differences between patients with UP and the control group. However, in the group of all HD patients, a significantly higher incidence of GA genotype and lower incidence in GG genotype in the polymorphism rs806381s were revealed versus the control group (p=0.04). It seems that polymorphisms of the CNR1 gene are not associated with uremic pruritus.

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