Pruritus bei inneren Erkrankungen

Skin Lesions, Skin Care, and Characteristics of Pruritus in Patients Undergoing Haemodialysis

INTRODUCTION

Pruritus has been shown to be a common and burdensome complaint in the general population. In some diseases, there is an even higher rate and intensity of pruritus such as in chronic kidney diseases. In particular, patients requiring dialysis commonly suffer from pruritus with proportions between 22.0 and 90.0%. Few data on the characteristics and burden of such pruritus have been published. Therefore, the aim of this study was to investigate the extent and profiles of pruritus in such patients related to skin lesions and care.

METHODS

A non-interventional cross-sectional study in 14 centres for haemodialysis across Germany was conducted. The survey explored the prevalence, severity, and resulting burden of pruritus and skin lesions.

RESULTS

In total, 302 patients with uraemia (56.5% male, mean age 66.0 ± 14.4 years, mean duration of dialysis 3.9 ± 4.8 years) were included. Skin lesions appeared since start of dialysis in 50.0% of patients, with xerosis (94.7%) and desquamation (25.8%) being the most frequent and disturbing findings. Pruritus was reported by 60.9% of patients undergoing dialysis with a current mean numerical rating scale of 5.1 ± 2.4 occurring most frequently in the back, legs, and arms. About 89.0% of patients with xerosis and 69.0% with desquamation reported self-medication. However, only 40.0% and 28.0% sought medical help, respectively, indicating a remarkable lack of healthcare.

DISCUSSION

The current data suggest a more intensive focus on the skin symptoms and signs related to uraemia in the patients with dialysis and thus underline claims from a previous German large-scale study. Recommendations for early treatment and prevention of skin lesions in dialysis patients should be developed. Further research should be conducted focusing on recognizing subgroups of patients of particular vulnerability to pruritus and skin lesions, which may facilitate identifying patients at risk in an early moment. Moreover, a more specific tool for screening of skin lesions as well as pruritus may be useful since the existing instruments lack such specificity.

How do nephrologists in haemodialysis units consider the symptom of itch? Results of a survey in Germany

BACKGROUND

Despite advances in dialysis treatment of end-stage renal disease, pruritus remains a widespread and distressing concomitant of chronic renal failure. The prevalence of uraemic pruritus (UP) across countries ranges from 10 to 77%. Data from the DOPPS study showed that moderate to severe UP occurs in >40% of patients on haemodialysis. We aimed to provide data on how common and how serious a problem pruritus is as perceived by nephrologists in daily haemodialysis practice. Method. A national cross-sectional survey in 1420 nephrologists assessed information on the number of dialysed patients, gender distribution, perceived prevalence of UP, time-related aspects of UP, characteristics of UP and its association with dialysis and therapy of UP.

RESULTS

Most respondents reported UP to be prevalent in 1-30% of their patients, and 30% reported an association between UP and dialysis. Seventy-five percent reported an undulating pattern. Nearly half the sample suggested a relationship between quality of dialysis and UP. No substantial differences in recognition and management of UP as a function of organizational affiliation were detected.

CONCLUSIONS

The prevalence of UP may be underestimated by nephrologists. Large variation in the reported prevalence of UP and the undulating pattern of UP after dialysis may impede the recognition of UP.