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Shetty D, Nayak AM, Datta D, Bhojaraja MV, Nagaraju SP, Prabhu AR, Rangaswamy D, Rao IR, Shenoy SV, Joshi D. Uremic pruritus: prevalence, determinants, and its impact on health-related quality of life and sleep in Indian patients undergoing hemodialysis. Ir J Med Sci 2023; 192:3109-3115. [PMID: 37171573 PMCID: PMC10691999 DOI: 10.1007/s11845-023-03393-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Uremic pruritus has an impact on the quality of life and sleep of hemodialysis patients, but the majority of cases go unreported and untreated unless severe, due to a lack of awareness. The purpose of this study is to determine the prevalence, associated factors, and impact on health-related quality of life (HR-QOL) and sleep in hemodialysis patients. METHODOLOGY A single-center observational study of 3 months wherein 120 adults on maintenance hemodialysis were included. Baseline characteristics, dialysis-related factors, and lab parameters influencing uremic pruritus were recorded. Those with uremic pruritus completed "12-item pruritus severity scale (12-PSS)", "SKINDEX10", and "Itch-MOS" questionnaires to evaluate severity, impact on HR-QOL, and sleep respectively. RESULTS Sixty seven over one hundred twenty (55.83%) patients had pruritus and majority were mild (40.83%) as per 12-PSS. Those with pruritus (n=67) had a mean age of 56.5±11.3 years, most were males (82%), chronic glomerulonephritis (29.1%) was the commonest cause of end-stage kidney disease, 3 active smokers, and 4 seropositive. 65(97%) patients were on twice-weekly dialysis, 36/67 had <5 years' dialysis vintage and acceptable adequacy. There was no significant association between uremic pruritus and dialysis-related/laboratory parameters. Patients with uremic pruritus demonstrated significantly worse "HR-QOL" (p<0.001) on the "SKINDEX-10", and patients' "Itch-MOS" scores demonstrated a significant decline in sleep quality with increasing pruritus severity (p<0.001). CONCLUSION The majority of patients on maintenance hemodialysis experience uremic pruritus. None of the clinical characteristics, dialysis-related factors, and laboratory parameters affected uremic pruritus. Uremic pruritus patients had the worst HR-QOL & their sleep quality significantly declined as pruritus severity escalated. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION Study approval was obtained from Institutional Research Committee and Institutional Ethical Committee (IEC 642/2021). Clinical Trial Registry of India (CTRI) registration (CTRI/2022/01/039143) was also obtained.
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Affiliation(s)
- Deeksha Shetty
- Renal Replacement Therapy and Dialysis Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Ajith M Nayak
- Renal Replacement Therapy and Dialysis Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Divya Datta
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Mohan V Bhojaraja
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Attur Ravindra Prabhu
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Dharshan Rangaswamy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Srinivas Vinayak Shenoy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Dhruv Joshi
- Renal Replacement Therapy and Dialysis Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
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2
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Prasad B, Gagarinova M, Sharma A. Five Things to Know About Pruritus in Patients on Dialysis. Can J Kidney Health Dis 2023; 10:20543581221149620. [PMID: 36711226 PMCID: PMC9880569 DOI: 10.1177/20543581221149620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/30/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Bhanu Prasad
- Division of Nephrology, Department of
Medicine, Regina General Hospital, SK, Canada,Bhanu Prasad, Nephrologist, Division of
Nephrology, Department of Medicine, Regina General Hospital, 1440 14th Avenue,
Regina, SK S4P 0W5, Canada.
| | | | - Aditi Sharma
- Dr. T Bhanu Prasad Medical Prof Corp,
Regina, SK, Canada
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Zhang L, Li Y, Xiao X, Shi Y, Xu D, Li N, Deng Y. Acupuncture for Uremic Pruritus: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2023; 65:e51-e62. [PMID: 36055470 DOI: 10.1016/j.jpainsymman.2022.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/26/2022] [Accepted: 08/23/2022] [Indexed: 02/03/2023]
Abstract
Uremic pruritus (UP) is a chronic disease that can seriously affect the quality of life of dialysis patients. Acupuncture is a non-medication therapy that has been used to treat pruritus disorders. This systematic review aimed to evaluate the efficacy and safety of acupuncture for the treatment of UP. A total of nine Chinese and English databases were searched from their inception to December 31, 2021, and 214 studies were retrieved. Finally, seven randomized controlled trials (n=504) were included in the meta-analysis performed using RevMan V.5.3. Results included effective rate, recurrence rates, and adverse events. Compared with conventional treatment, acupuncture was more effective in treating UP (risk ratio [RR]=1.28, 95% confidence interval [CI]=1.09 to 1.50, P=0.003). The results were consistent after sensitivity analysis (RR=1.38, 95% CI=1.21 to 1.57, P<0.00001). In subgroup analysis, the efficacy rates of acupuncture and medications (oral and topical) were comparable (RR=1.20, 95% CI=0.98 to 1.47, P=0.07). Acupuncture combined with hemodialysis was more effective than hemodialysis alone in relieving pruritus (RR=1.42, 95% CI=1.18 to 1.72, P=0.0002). Adverse events were reported in only three studies, including one case of hyperphosphatemia in the medications group (RR=0.29, 95% CI=0.01 to 7.06, P=0.45). None of the studies reported recurrence rates. In conclusion, acupuncture is a safe treatment modality for patients with UP receiving hemodialysis that can effectively improve UP symptoms, and acupuncture in combination with hemodialysis has more efficacy than hemodialysis alone in improving the UP symptoms.
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Affiliation(s)
- Leixiao Zhang
- Department of Integrated Traditional Chinese and Western Medicine (L.Z., N.L.), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yiwei Li
- Sichuan Second Chinese Medicine Hospital (Y.L., D.X., Y.D.), Chengdu, Sichuan, China
| | - Xianjun Xiao
- Chengdu University of Traditional Chinese Medicine (X.X., Y.S.), Chengdu, Sichuan, China
| | - Yunzhou Shi
- Chengdu University of Traditional Chinese Medicine (X.X., Y.S.), Chengdu, Sichuan, China
| | - Dongxian Xu
- Sichuan Second Chinese Medicine Hospital (Y.L., D.X., Y.D.), Chengdu, Sichuan, China
| | - Ning Li
- Department of Integrated Traditional Chinese and Western Medicine (L.Z., N.L.), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanli Deng
- Sichuan Second Chinese Medicine Hospital (Y.L., D.X., Y.D.), Chengdu, Sichuan, China.
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Ge WQ, Zhan-Mu OY, Chen C, Zhang H, Wang XY, Liu X, Li L, Lan YY, Li CN, Sun JC, Shi RL, Dou ZY, Pan HL, Li HP, Jing XH, Li M. Electroacupuncture reduces chronic itch via cannabinoid CB1 receptors in the ventrolateral periaqueductal gray. Front Pharmacol 2022; 13:931600. [PMID: 36133809 PMCID: PMC9483028 DOI: 10.3389/fphar.2022.931600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic itch severely reduces the quality of life of patients. Electroacupuncture (EA) is widely used to treat chronic itch. However, the underlying mechanism of this therapeutic action of EA is largely unknown. Cannabinoid CB1 receptors in the ventrolateral periaqueductal gray (vlPAG) mediate the analgesic effect of EA. Using a dry skin-induced itch model in mice, we determined whether EA treatment reduces chronic itch via CB1 receptors in the vlPAG. We showed that the optimal inhibitory effect of EA on chronic itch was achieved at the high frequency and high intensity (100 Hz and 3 mA) at “Quchi” (LI11) and “Hegu” (LI14) acupoints, which are located in the same spinal dermatome as the cervical skin lesions. EA reversed the increased expression of CB1 receptors in the vlPAG and decreased the concentration of 5-hydroxytryptamine (5-HT) in the medulla oblongata and the expression of gastrin-releasing peptide receptors (GRPR) in the cervical spinal cord. Furthermore, knockout of CB1 receptors on GABAergic neurons in the vlPAG attenuated scratching behavior and the 5-HT concentration in the medulla oblongata. In contrast, knockout of CB1 receptors on glutamatergic neurons in the vlPAG blocked the antipruritic effects of EA and the inhibitory effect of EA on the 5-HT concentration in the medulla oblongata. Our findings suggest that EA treatment reduces chronic itch by activation of CB1 receptors on glutamatergic neurons and inhibition of CB1 receptors on GABAergic neurons in the vlPAG, thereby inhibiting the 5-HT release from the medulla oblongata to GRPR-expressing neurons in the spinal cord. Our findings suggest that EA attenuates chronic itch via activating CB1 receptors expressed on glutamatergic neurons and downregulating CB1 receptors on GABAergic neurons in the vlPAG, leading to the reduction in 5-HT release in the rostroventral medulla and GRPR signaling in the spinal cord. Our study not only advances our understanding of the mechanisms of the therapeutic effect of EA on chronic itch but also guides the selection of optimal parameters and acupoints of EA for treating chronic itch.
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Affiliation(s)
- Wen-Qiang Ge
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Ou-Yang Zhan-Mu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Chao Chen
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Hong Zhang
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
| | - Xin Liu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Li
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu-Ye Lan
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Chen-Nan Li
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Jia-Can Sun
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Run-Lin Shi
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zi-Yue Dou
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Hui-Lin Pan
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hong-Ping Li
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hong-Ping Li, ; Xiang-Hong Jing, ; Man Li,
| | - Xiang-Hong Jing
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
- *Correspondence: Hong-Ping Li, ; Xiang-Hong Jing, ; Man Li,
| | - Man Li
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hong-Ping Li, ; Xiang-Hong Jing, ; Man Li,
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Cheng AY, Wong LS. Uremic Pruritus: From Diagnosis to Treatment. Diagnostics (Basel) 2022; 12:diagnostics12051108. [PMID: 35626264 PMCID: PMC9140050 DOI: 10.3390/diagnostics12051108] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 12/15/2022] Open
Abstract
Uremic pruritus, or chronic kidney disease-associated pruritus, is common, bothersome, and sometimes debilitating in patients with chronic kidney disease or end-stage renal disease. Due to its variable clinical manifestations, the diagnosis of uremic pruritus requires exquisite evaluation. Excluding itch resulting from other dermatological causes as well as other systemic conditions is essential for a proper diagnosis. The pathophysiology of uremic pruritus remains uncertain. Hypotheses including toxin deposition, immune system dysregulation, peripheral neuropathy, and opioid imbalance are supposed. This review summarizes the way to accurately diagnose uremic pruritus and describes the latest treatment options.
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Affiliation(s)
| | - Lai-San Wong
- Correspondence: ; Tel.: +886-7-731-7123 (ext. 2299)
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6
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Reduction of serum level of interleukin-2 and pruritus severity after acupuncture at Quchi (LI11) in hemodialysis patients: a placebo-controlled randomized clinical trial. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2022. [DOI: 10.1007/s11726-022-1299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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7
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Świerczyńska K, Białynicki-Birula R, Szepietowski JC. Chronic Intractable Pruritus in Chronic Kidney Disease Patients: Prevalence, Impact, and Management Challenges - A Narrative Review. Ther Clin Risk Manag 2021; 17:1267-1282. [PMID: 34876816 PMCID: PMC8643219 DOI: 10.2147/tcrm.s310550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/14/2021] [Indexed: 12/27/2022] Open
Abstract
Chronic kidney disease (CKD) is recognized as a leading public health problem and causes numerous health complications. One of the most common and burdensome dermatological symptoms affecting patients undergoing dialysis is CKD-associated pruritus (CKD-aP). This condition not only has a negative impact on sleep, mood, daily activities, and quality of life but also increases the mortality risk of hemodialyzed patients. Despite that, this condition is greatly underestimated in clinical practice. Due to the complex and still not fully understood etiopathogenesis of CKD-aP, the choice of an effective therapy remains a challenge for clinicians. Most common therapeutic algorithms use topical treatment, phototherapy, and various systemic approaches. This review aimed to summarize most recent theories about the pathogenesis, clinical features, and treatment of CKD-aP.
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Affiliation(s)
- Karolina Świerczyńska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Rafał Białynicki-Birula
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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8
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Lanot A, Kottler D, Béchade C. [Pruritus associated chronic kidney disease]. Nephrol Ther 2021; 17:488-495. [PMID: 34654672 DOI: 10.1016/j.nephro.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
Pruritus associated with chronic kidney disease is a frequent and disabling symptom in patients with severe chronic kidney disease treated by dialysis. It is associated with a poor quality of life, an increased risk of comorbidities and even mortality. Nevertheless, its prevalence is underestimated by nephrologists. The pathophysiology of pruritus associated with chronic kidney disease is not well understood, but several mechanisms seem to contribute to its occurrence: accumulation and skin deposition of uremic toxins, peripheral neuropathy causing an activation of the pruritogenic cowhage pathway, chronic microinflammation, opioid imbalance, and kidney disease-related skin xerosis. Optimization of the treatment of chronic kidney disease treatment, of dialysis parameters, and general skin care measures should always be performed prior to the introduction of systemic therapy targeting one or more of these mechanisms. The available therapeutic trials remain mostly at high risk of bias, with small patient numbers. Gabapentinoids are the molecules recommended as first-line therapy. Peripheral opioid agonists could find a place of choice in the treatment of pruritus associated with chronic kidney disease and will soon be available in France. The low level of evidence for the other molecules does not currently allow us to specify a second-line treatment for this condition.
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Affiliation(s)
- Antoine Lanot
- UNICAEN, néphrologie, Normandie université, CHU de Caen Normandie, 14000 Caen, France; UNICAEN, UFR de médecine, Normandie Université, 2, rue des Rochambelles, 14032 Caen cedex, France; ANTICIPE U1086 Inserm-UCN, centre François-Baclesse, 14000 Caen, France.
| | - Diane Kottler
- UNICAEN, dermatologie, Normandie Université, CHU de Caen Normandie, 14000 Caen, France
| | - Clémence Béchade
- UNICAEN, néphrologie, Normandie université, CHU de Caen Normandie, 14000 Caen, France; UNICAEN, UFR de médecine, Normandie Université, 2, rue des Rochambelles, 14032 Caen cedex, France; ANTICIPE U1086 Inserm-UCN, centre François-Baclesse, 14000 Caen, France
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Makar M, Smyth B, Brennan F. Chronic Kidney Disease-Associated Pruritus: A Review. Kidney Blood Press Res 2021; 46:659-669. [PMID: 34515143 DOI: 10.1159/000518391] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic kidney disease-associated pruritus (CKD-aP), also known as uraemic pruritus, is a disabling symptom for patients and a challenging condition for clinicians. Despite being common amongst end-stage kidney disease (ESKD) patients, it remains underestimated and underdiagnosed. The exact pathogenesis remains largely elusive, which hampers the synthesis of a definite treatment approach. SUMMARY Chronic pruritus (lasting 6 weeks or more in duration) is a common and potentially disabling symptom in patients with advanced CKD. A unified hypothesis of pathogenesis has not yet been concluded. Studies have shown changes in the immunochemical milieu of the skin in patients with CKD-aP with several inciting stimuli identified. However, other unrecognized factors are likely to be involved. This article will review the current observations and understanding of the postulated pathogenesis of CKD-aP, as well as the evidence for current management strategies. Key Messages: CKD-aP is a common and troubling symptom amongst ESKD patients that is associated with decreased quality of life and poor prognosis. Its exact pathogenesis, at the time of writing, is not well-understood. A stepwise approach is recommended for management. Systematic reviews show the largest body of evidence was found for the effectiveness of gabapentin. Comparison is needed between newly emerging pharmacological agents such as kappa-opioid receptor agonists and more established agents, such as the gabapentinoids. Finally, renal transplantation should be considered in severe and refractory cases who are suitable transplant candidates as it has shown an excellent outcome in most cases.
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Affiliation(s)
- Maria Makar
- Department of Renal Medicine, St. George Hospital, Kogarah, New South Wales, Australia,
| | - Brendan Smyth
- Department of Renal Medicine, St. George Hospital, Kogarah, New South Wales, Australia
| | - Frank Brennan
- Department of Renal Medicine, St. George Hospital, Kogarah, New South Wales, Australia
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Rao SR, Vallath N, Siddini V, Jamale T, Bajpai D, Sancheti NN, Rangaswamy D. Symptom Management among Patients with Chronic Kidney Disease. Indian J Palliat Care 2021; 27:S14-S29. [PMID: 34188374 PMCID: PMC8191745 DOI: 10.4103/ijpc.ijpc_69_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/05/2021] [Indexed: 11/04/2022] Open
Abstract
Patients with chronic kidney disease (CKD) experience high symptom burden, both physical and psychological, that is underrecognized and undertreated. The high symptom burden significantly impacts the quality of life for patients and their families. This review enumerates the various physical and psychological symptoms that patients with CKD often experience and guides in the management of these symptoms. This review follows the recommended international guidelines and has been tailored to suit the Indian context.
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Affiliation(s)
- Seema Rajesh Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
- APHN Palliative Care Consultant for Lien Collaborative for Palliative Care, Asia Pacific Hospice Palliative Care Network, Singapore
- Honorary Tutor, School of Medicine, Cardiff University, UK
| | - Nandini Vallath
- Clinical consultant, BARC Hospital, Mumbai, India
- Division of Palliative Care and Medical Humanities, KEM Hospital, Mumbai, India
- Palliative Care Lead, National Cancer Grid-India
| | | | - Tukaram Jamale
- Department of Nephrology, Seth GS Medical College and KEM Hospital, Mumbai,India
| | - Divya Bajpai
- Department of Nephrology, Seth GS Medical College and KEM Hospital, Mumbai,India
| | - Nitish Nitin Sancheti
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, India
| | - Dharshan Rangaswamy
- Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Kim KY, Kim JSTW, Tsai AWW, Hsing WT. Acupuncture for the Treatment of Itch: Literature Review and Future Perspectives. Med Acupunct 2021; 33:137-143. [PMID: 33912270 DOI: 10.1089/acu.2020.1445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Chronic pruritus is a prevalent, multifactorial and debilitating condition that is often underestimated. This article reviews current evidence to evaluate the efficacy of acupuncture for the treatment of itch. Results: Although many researchers have conducted observational studies, clinical trials, and systematic reviews on the subject, the lack of more-robust and well-designed studies to prove the effectiveness of acupuncture in the management of itch is evident. Many published studies are of poor quality, with no clear description of randomization methods, and an absence of control groups and measurable clinical outcomes. In addition, a lack of standardization in methods for assessing pruritus and the acupuncture treatment protocols hinders more-comprehensive and higher-quality pooled data analysis. Conclusions: Current evidence cannot fully support acupuncture for the treatment of itch yet.
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Affiliation(s)
- Kevin Yun Kim
- Acupuncture Center of the Orthopedics and Traumatology Institute, University of São Paulo Medical School, São Paulo, Brazil
| | | | - André Wan Wen Tsai
- Acupuncture Center of the Orthopedics and Traumatology Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Wu Tu Hsing
- Acupuncture Center of the Orthopedics and Traumatology Institute, University of São Paulo Medical School, São Paulo, Brazil
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Li HP, Wang XY, Chen C, Li JJ, Yu C, Lin LX, Yu ZE, Jin ZY, Zhu H, Xiang HC, Hu XF, Cao J, Jing XH, Li M. 100 Hz Electroacupuncture Alleviated Chronic Itch and GRPR Expression Through Activation of Kappa Opioid Receptors in Spinal Dorsal Horn. Front Neurosci 2021; 15:625471. [PMID: 33664646 PMCID: PMC7921323 DOI: 10.3389/fnins.2021.625471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background Clinical studies have shown that electroacupuncture (EA) alleviates chronic itch. Gastrin-releasing peptide receptor (GRPR) and dynorphin (DYN) in the spinal dorsal horn positively or negatively regulate itch, respectively. However, which frequency of EA is effective on relieving chronic itch and reducing the expression of GRPR, whether DYN-A in the spinal cord is involved in the underlying mechanism of the antipruritus effect of EA remains unknown. Methods The mixture of acetone and diethyl ether (1:1) [designated as AEW (acetone/diethyl ether and water) treatment] was used to induce the dry skin model of chronic itch. EA was applied to Quchi (LI11) and Hegu (LI4). Western blot was used to detect the expression of GRPR and DYN-A. Immunofluorescence was used to detect the expression of DYN-A. Results The AEW administration induced remarkable spontaneous scratching, enhanced the expression of GRPR, and reduced the expression of DYN-A. Compared with the sham EA, 2 Hz EA, or 15 Hz EA group, 100 Hz EA was the most effective frequency for relieving chronic itch, reducing the expression of GRPR, and increasing the expression of DYN-A in the cervical dorsal horn. Furthermore, intraperitoneal injection of kappa opioid receptors (KORs) antagonist nor-Binaltorphimine dihydrochloride (nor-BNI) significantly reversed the effect of 100 Hz EA on the inhibition of both itching behavior and GRPR expression. Conclusion EA at 100 Hz is the most effective frequency that inhibits chronic itch and GRPR expression through activation of KORs in the spinal dorsal horn, which can effectively guide the clinical treatment and improve the antipruritic effect of acupuncture.
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Affiliation(s)
- Hong-Ping Li
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chao Chen
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing-Jing Li
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chi Yu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li-Xue Lin
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zi-E Yu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi-Yuan Jin
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - He Zhu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Chun Xiang
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue-Fei Hu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Cao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang-Hong Jing
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Man Li
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Efficacy of uremic pruritus treatment in patients undergoing hemodialysis, a network meta-analysis for randomized clinical trials. Nephrol Ther 2020; 17:30-34. [PMID: 33203613 DOI: 10.1016/j.nephro.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/01/2020] [Accepted: 09/02/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Uremic pruritus is very common in hemodialysis or renal failure patients, there were lots of available treatments such as gabapentin, pregabalin, ondansetron, etc. However, there is no quantified study comparing these treatments together, it is impossible to conduct a clinical trial involving so many treatments, so we conduct a network meta-analysis to compare them. METHOD We collected mean difference and standard error of visual analogue scale data as outcome. In total we collected 15 articles, 15 articles, 1180 subjects and 6 treatments included to this study. RESULTS In these comparisons, gabapentin showed the largest effect MD: 5.19, 95%CI [3.77, 6.61], anti-histamine MD: 4.65, 95%CI [2.22, 7.07] and pregabalin MD: 4.62, 95%CI [2.71, 6.62] showed a similar effect. Opioid pathway related treatment also showed a significant but not so large effect MD: 2.45, 95%CI [0.41, 4.49]. Ondansetron and Doxepin didn't show a significant improvement among placebo, the overall quantifying heterogeneity I2=43.1%. There is no statically difference between gabapentin, pregabalin and anti-histamine treatments. CONCLUSIONS So we conclude that gabapentin, pregabalin and anti-histamine has a similar efficacy on pruritus control.
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Yeam CT, Yo TE, Tan YLC, Liew A, Seng JJB. Complementary and alternative medicine therapies for uremic pruritus - A systematic review of randomized controlled trials. Complement Ther Med 2020; 56:102609. [PMID: 33197658 DOI: 10.1016/j.ctim.2020.102609] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/26/2020] [Accepted: 10/30/2020] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Uremic pruritus (UP) is one of the most bothersome symptoms among chronic kidney disease (CKD) patients. The pathophysiology of UP remains elusive, resulting in limited treatment options. The inability of standard medical treatments to provide effective relief has piqued interest in complementary and alternative medicine (CAM). METHODOLOGY A systematic review of randomized controlled trials (RCTs) summarizing the efficacy and safety profile of CAM used for UP in CKD patients was performed. CAM interventions were classified using categories proposed by the National Center for Complementary and Integrative Health. The efficacy of each CAM was determined from changes in UP severity and all reported adverse effects were extracted. RESULTS Of 5242 articles screened, 34 RCTs were included, with 15 (44.1 %) studies having a sample size greater than 50. The studies considered 21 treatments including omega-3 fatty acid supplementation (n=5), acupuncture (n=5), topical capsaicin (n=4) and acupressure (n=3). Acupuncture, acupressure and topical capsaicin were shown to be effective in improving uremic pruritus. Interventions which include oral omega-3 fatty acid and zinc supplementation demonstrated mixed efficacy. Other therapies such as evening primrose oil, turmeric, vitamin B3, vitamin D and thermal therapy were not effective for treatment of UP. Common adverse effects reported with topical capsaicin included mild burning sensations (50.0-88.2 %) or erythema (6.7-22.7%) while that of acupuncture included soreness (7.5 %), bleeding (6.0-7.5%) and hematoma (1.9 %). CONCLUSIONS Acupuncture, acupressure and topical capsaicin have the largest body of evidence for efficacy in the treatment of UP. Larger and higher quality RCTs are required to examine the efficacy and safety of promising CAM.
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Affiliation(s)
- Cheng Teng Yeam
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | - Tiffany Eri Yo
- Department of Pharmacy, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore.
| | - Ying Lin Cheryl Tan
- Department of Pharmacy, Singapore General Hospital, 16 College Road, 169608, Singapore.
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, 38 Irrawaddy Road, Singapore 329563, Singapore.
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Kushnir V, Dmytrenko S, Katilov O, Kushnir N. Itching as the onset of pain (part 3). PAIN MEDICINE 2020. [DOI: 10.31636/pmjua.v5i2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Itchy skin is an extremely unpleasant symptom that can provoke insomnia, depression, irritability, loss of appetite. There are several theories of itching. According to one of them, itching is a modified pain caused by a slight irritation of the nerve endings in the skin. According to the second, itching is an independent symptom, in the formation of which nervous, humoral and vascular mechanisms are involved. Other theories consider itching as a reaction of the autonomic nervous system or a hereditary pathological condition. According to recent studies, itchy skin is characterized by the absence of a universal peripheral mediator of itching. The trigger for itching is the action of pruritogen – a mechanical, chemical, thermal or electrical stimulant directly or indirectly through mediators. Free ends of type A delta fibers and type C fibers play a crucial role in itching and pain. If this was previously confirmed only by clinical observations, now there are neurophysiological studies that support the theory that itching and pain fibers are one with different activity thresholds. Today, it is unacceptable that there are separate specific receptors for different sensations. It is now assumed that there are mixed receptors for heat, cold, pain, itching and touch [95]. Systematic use of substances included in the list of drugs and manifested by mental and physical dependence on them – drug addiction, one of the diseases of society. But drug addiction is sometimes forced, according to medical indications, in cases of palliative conditions. Depending on the stage of the person after taking the drug or in the interval between drug use, one of the signs of use may be severe itching of the skin. And after excluding both the main diseases that cause itching and other secondary causes of itching, it can be assumed that a person has idiopathic generalized pruritus (itching) of unknown origin (GPOU). The itching of the elderly, which is quite common in the elderly, as a manifestation of concomitant, often combined, somatic pathology, but may also be due to physiological changes, both on the skin and on the physiological aging of nerve endings.
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Verduzco HA, Shirazian S. CKD-Associated Pruritus: New Insights Into Diagnosis, Pathogenesis, and Management. Kidney Int Rep 2020; 5:1387-1402. [PMID: 32954065 PMCID: PMC7486142 DOI: 10.1016/j.ekir.2020.04.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/19/2022] Open
Abstract
Chronic kidney disease–associated pruritus (CKD-aP) is a common, troubling and in some cases debilitating problem for patients with CKD and end-stage renal disease. Despite a prevalence rate of approximately 20% in CKD and 40% in end-stage renal disease, and a clear association with poorer psychosocial and medical outcomes, this condition is often underreported by patients and overlooked by health care providers. This is likely due, in part, to uncertainty regarding its pathogenesis and treatment. Most commonly, CKD-aP is attributed to toxin build-up, peripheral neuropathy, immune system dysregulation, or opioid dysregulation. Prior treatment studies of CKD-aP have targeted these potential etiologies but have been limited by noncontrolled design, small sample size, and non-uniform definitions of CKD-aP. Recently, several large, randomized controlled trials targeting opioid dysregulation have yielded promising results. These trials have spurred new hope for understanding and treating this condition.
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Affiliation(s)
- Hector Alvarado Verduzco
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Shayan Shirazian
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, New York, USA
- Correspondence: Shayan Shirazian, Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH4-124, New York, New York, USA.
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Charcoal for the management of pruritus and uremic toxins in patients with chronic kidney disease. Curr Opin Nephrol Hypertens 2020; 29:71-79. [DOI: 10.1097/mnh.0000000000000567] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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18
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Impact of Pruritus on Sleep Quality of Hemodialysis Patients: A Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2019; 55:medicina55100699. [PMID: 31627446 PMCID: PMC6843221 DOI: 10.3390/medicina55100699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 11/17/2022]
Abstract
Background and objectives: Chronic kidney disease (CKD)-associated pruritus is a common and disturbing condition which has a negative impact on sleep quality, as well as overall health-related quality of life of patients receiving hemodialysis. To date, no systematic review has been undertaken, and there is a lack of concise evidence that statistically quantifies the impact of pruritus based on published data. Materials and Methods: A systematic search was done for original articles published in peer-reviewed English journals from database inception on 20 December, 2018, in the following databases: PubMed, MEDLINE, EMBASE, Ovid, CINHAL, ProQuest, and Scopus. Results: A total of 9217 research articles were identified. After removal of duplicates and screening for titles and abstracts, 28 articles were selected. The prevalence of disturbed sleep was 4–94%, while the pooled proportion on random effect in the study was 40% (95% CI = 0.30 to 0.49); I2 = 99.8%. However, the prevalence of disturbed sleep quality and quantity due to pruritus was 9–76%, and the pooled proportion on random effect in the study was 50% (95% CI = 0.37 to 0.64); I2 = 99.8%. Conclusions: Patients undergoing hemodialysis who are affected by CKD-associated pruritus have a higher chance of experiencing sleep disturbances. The prevalence of disturbed sleep due to CKD-associated pruritus was found to be 9–76% in the included studies for patients receiving hemodialysis therapy.
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Rehman IU, Lai PSM, Lim SK, Lee LH, Khan TM. Sleep disturbance among Malaysian patients with end-stage renal disease with pruritus. BMC Nephrol 2019; 20:102. [PMID: 30909887 PMCID: PMC6434782 DOI: 10.1186/s12882-019-1294-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/13/2019] [Indexed: 11/24/2022] Open
Abstract
Background Chronic kidney disease-associated pruritus (CKD-aP) is a well-recognized, frequent and compromising complication among patients on hemodialysis. Despite advancement in basic medical sciences, CKD-aP is still a major complication and a challenge for both physicians and patients to manage. The aim of this study was to estimate the prevalence of CKD-aP among hemodialysis patients in Malaysia, to determine the impact of CKD-aP on sleep quality and any factors associated with CKD-aP. Method A multi-centered, cross-sectional study design was conducted from February 2017 to September 2017 at a tertiary hospital and its affiliated dialysis centers, in Kuala Lumpur, Malaysia. Included were patients > 18 years of age who were undergoing hemodialysis and could understand Malay. Participants were asked to fill the Malay 5D-itch scale and the Malay Pittsburgh sleep quality index (PSQI) upon recruitment. Results A total of 334/334 patients were recruited (response rate = 100%). The majority were male (59.6%) and Chinese (61.7%). A total of 61.3% had pruritus, of which most patients (63.4%) reported that their pruritus was mild. More than half (54.1%) reported that they slept > 6 h, and 93.2% experienced no sleep disturbances during the night. However; the overall PSQI median score [IQR] was 6.0 [5.0–9.0]. No significant association was found between demographic and clinical characteristics of patients with the severity of pruritus. Patients with moderate to severe pruritus were found to be 5.47 times more likely to experience poor sleep quality as compared to patients with mild or no pruritus. Conclusion In Malaysia, the prevalence of CKD-aP was 61.3%, of which the majority reported that their pruritus was mild. Patients with moderate to severe pruritus were found to be 5.47 times more likely to experience poor sleep quality as compared to patients with mild or no pruritus.
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Affiliation(s)
- Inayat Ur Rehman
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor Darul Ehsan, Malaysia. .,Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan.
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soo Kun Lim
- Department of Medicine (Division of Nephrology), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Learn Han Lee
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor Darul Ehsan, Malaysia.,Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia.,Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, 510006, Guangzhou, People's Republic of China.,Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor Darul Ehsan, Malaysia. .,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Science, Outfall Campus, Civil Lines, Lahore, Pakistan.
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Adib-Hajbaghery M, Nabizadeh-Gharghozar Z, Nasirpour P. Bias in clinical trials into the effects of complementary and alternative medicine therapies on hemodialysis patients. J Family Med Prim Care 2019; 8:2179-2183. [PMID: 31463227 PMCID: PMC6691419 DOI: 10.4103/jfmpc.jfmpc_186_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Chronic renal failure is among the major health challenges in the world. Many clinical trials have been conducted to assess the effects of complementary and alternative therapies on hemodialysis-related outcomes. However, a number of biases may affect the results of these studies. Aims: This study aimed to assess biases in randomized clinical trials into the effects of complementary and alternative therapies on hemodialysis patients. Settings and Design: A critical review on clinical trials into the effects of complementary and alternative therapies therapies on hemodialysis patients. Materials and Methods: This study was conducted on 114 randomized clinical trials which had been published in 2012–2017 into the effects of complementary and alternative therapies on hemodialysis patients. The Cochrane Risk of Bias Tool was employed to assess biases in the included trials. The collected data were presented using the measures of descriptive statistics, namely absolute and relative frequencies. Results: Among 114 included trials, 71.05% (81 trials) had used low bias methods for random sequence generation, while 60.52% (69 trials) had provided no clear information about allocation concealment. Moreover, respecting blinding, 57.89% of trials (66 trials) were low bias. Around 60.52% of trials (69 trials) had no attrition between randomization and final follow-up assessment and 84.21% (96 trials) had apparently reported all intended outcomes. Conclusions: This study shows that 50% of randomized clinical trials into the effects of complementary and alternative therapies on hemodialysis patients have low bias. Yet, quality improvement is still needed to produce more conclusive evidence.
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Affiliation(s)
- Mohsen Adib-Hajbaghery
- Department of Nursing, Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Parisa Nasirpour
- Department of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Rehman IU, Munib S, Ramadas A, Khan TM. Prevalence of chronic kidney disease-associated pruritus, and association with sleep quality among hemodialysis patients in Pakistan. PLoS One 2018; 13:e0207758. [PMID: 30496235 PMCID: PMC6264857 DOI: 10.1371/journal.pone.0207758] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 11/06/2018] [Indexed: 12/27/2022] Open
Abstract
Background The prevalence of chronic kidney disease-associated pruritus (CKD-aP) varies from 22% to 84% among patients receiving hemodialysis. It occurs more frequently at night, and often affects patient’s sleep quality. CKD-aP is often unreported by patients, and many do not receive effective treatment. There is, however, a paucity of available data on the prevalence and impact of CKD-aP on patients receiving hemodialysis in Pakistan. Methods A multicenter cross-sectional study was undertaken from July 2016 to April 2017 at a tertiary care hospitals in Pakistan. Results 354 patients undergoing hemodialysis were studied. 35.6% had CKD for 1–2 years, and 42.4% were receiving hemodialysis for 1–2 years. The prevalence of pruritus was 74%. The median [interquartile range] score for pruritus was 10.0 (out of possible 25) [8.0–12.0]; while the median [interquartile range] Pittsburgh Sleep Quality Index (PSQI) score was 8.0 (out of possible 21) [7.0–10.0]'. Pruritus was significantly correlated with the sleep score (r = 0.423, p<0.001). The results of the multivariate linear regression revealed a positive association between pruritus and age of patients (β = 0.031; 95% CI = 0.002–0.061; p = 0.038) and duration of CKD (β = -0.013; 95% CI = -0.023 –-0.003; p = 0.014). Similarly there was a positive association between sleep score and duration of CKD (β = 0.010; 95% CI = 0.002–0.019; p = 0.012) and pruritus (β = 0.143; 95% CI = 0.056–0.230; p = 0.001). Conclusions Chronic kidney disease-associated pruritus is very common in patients receiving hemodialysis in Pakistan. Pruritus is significantly associated with poor sleep quality.
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Affiliation(s)
- Inayat Ur Rehman
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
- Department of Pharmacy, Abdul Wali Khan University, Mardan, Pakistan
- * E-mail: (TMK); (IUR)
| | - Syed Munib
- Department of Nephrology, Institute of Kidney diseases, Peshawar, Pakistan
| | - Amutha Ramadas
- Jeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
- Institute of Pharmaceutical Sciences (IPS), University of Veterinary & Animal Sciences (UVAS), Lahore, Pakistan
- * E-mail: (TMK); (IUR)
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Acupuncture Effect on Pruritus in Hemodialysis Patients: A Randomized Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2018. [DOI: 10.5812/ircmj.65521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Phan FA, Srilestari A, Mihardja H, Marbun MBH. Effects of acupuncture on uremic pruritus in patients undergoing hemodialysis. ACTA ACUST UNITED AC 2018. [DOI: 10.1088/1742-6596/1073/6/062049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Rehman IU, Chia DWB, Ahmed R, Khan NA, Rahman AU, Munib S, Lee LH, Chan KG, Khan TM. A randomized controlled trial for effectiveness of zolpidem versus acupressure on sleep in hemodialysis patients having chronic kidney disease-associated pruritus. Medicine (Baltimore) 2018; 97:e10764. [PMID: 30075491 PMCID: PMC6081075 DOI: 10.1097/md.0000000000010764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pruritus adds to the complications of chronic kidney disease (CKD) patient and a well-recognized complication among the CKD patients. Majority of the patients on hemodialysis experience a generalized pruritus and patients reported being moderately to extremely disturbed by at least one of the sleep-related condition. This study aim to investigate the effectiveness of zolpidem 10 mg and acupressure therapy on foot acupoints to improve the sleep quality and overall quality of life among hemodialysis patients suffering from CKD-associated pruritus. METHODS A multicentered, open-label, parallel group, prospective randomized controlled trial among patients suffering from CKD-associated pruritus with sleep disturbance, after randomization into control, and intervention group to be held at North West General Hospital and Research Center Peshawar, Pakistan and Institute of Kidney Diseases Peshawar, Pakistan. RESULTS The primary outcome is to investigate the effectiveness of zolpidem 10 mg and acupressure therapy on foot acupoints to improve the sleep quality and overall quality of life among hemodialysis patients suffering from CKD-associated pruritus. After baseline assessment by Urdu version of 5D itch scale and Urdu version of Pittsburgh Sleep Quality Index (PSQI) and Urdu EQ-5D 3L, the intervention group will be given zolpidem 10 mg oral tablets and control group with acupressure on both foots on KI-1 acupoints for total of 6 minutes. Assessment will be done at weeks 4 and 8 from baseline by using Urdu version of 5D itch scale and Urdu version of PSQI and Urdu EQ-5D 3L, whereas safety profiling of zolpidem 10 mg tablet at week 6 from baseline and acupressure acceptability at week 6 from baseline. Analysis of covariance will be used to examine the differences in treatment effects between the intervention and control groups. CONCLUSION Improvement of sleep quality and quality of life among patients with CKD-associated pruritus requires great importance. This study aims to improve the quality of sleep and quality of life among patients with hemodialysis suffering from CKD-associated pruritus.
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Affiliation(s)
- Inayat Ur Rehman
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
- Department of Pharmacy, Abdul Wali Khan University, Mardan
| | - David Wu Bin Chia
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
| | - Raheel Ahmed
- Department of Nephrology, Institute of Kidney Diseases
| | - Nisar Ahmad Khan
- Department of Nephrology, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Aziz Ur Rahman
- Department of Urology, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Syed Munib
- Department of Nephrology, Institute of Kidney Diseases
| | - Learn Han Lee
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
- Biomedical Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Kok Gan Chan
- International Genome Centre, Jiangsu University, Zhenjiang, China
- ISB (Genetics), Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Science, Outfall Campus, Civil Lines, Lahore, Pakistan
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Improved Itchy Quality of Life Following Topical Application of Sweet Almond Oil in Patients with Uremic Pruritus: A Randomized, Controlled Trial. ACTA ACUST UNITED AC 2018. [DOI: 10.5812/jjcdc.68164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Millington G, Collins A, Lovell C, Leslie T, Yong A, Morgan J, Ajithkumar T, Andrews M, Rushbook S, Coelho R, Catten S, Lee K, Skellett A, Affleck A, Exton L, Mohd Mustapa M, Levell N, McHenry P, Gibbon K, Buckley D, Leslie T, Mallon E, Wakelin S, Ungureanu S, Hunasehally R, Cork M, Johnston G, Chiang N, Natkunarajah J, Worsnop F, Duarte Williamson C, Donnelly J, Towers K, Saunders C, Adbi Salad A, Brain A. British Association of Dermatologists’ guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018. Br J Dermatol 2018; 178:34-60. [DOI: 10.1111/bjd.16117] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2017] [Indexed: 12/20/2022]
Affiliation(s)
- G.W.M. Millington
- Dermatology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - A. Collins
- Haematology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - C.R. Lovell
- Dermatology Department Royal United Hospital Combe Park Bath BA1 3NG U.K
| | - T.A. Leslie
- Dermatology Department Royal Free Hospital Pond Street London NW3 2QGU.K
| | - A.S.W. Yong
- Dermatology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - J.D. Morgan
- General Practitioner Chet Valley Medical Practice 40–48 George Lane London NR14 6QH U.K
| | - T. Ajithkumar
- Oncology Department Addenbrooke's Hospital Hills Road Cambridge CB2 2QQ U.K
| | - M.J. Andrews
- Nephrology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - S.M. Rushbook
- Hepatology Unit Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - R.R. Coelho
- Dermatology Department St George's Hospital Blackshaw Road London SW17 0QT U.K
| | - S.J. Catten
- Dermatology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - K.Y.C. Lee
- Dermatology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - A.M. Skellett
- Dermatology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - A.G. Affleck
- Dermatology Department Ninewells Hospital Dundee DD1 9SY U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - N.J. Levell
- Dermatology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
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Rehman IU, Khan TM. Validity and reliability of the Urdu version of the 5D itching scale to assess pruritus among patients with chronic kidney disease in Pakistan. BMC Nephrol 2017; 18:302. [PMID: 28969584 PMCID: PMC5625599 DOI: 10.1186/s12882-017-0717-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 09/19/2017] [Indexed: 12/13/2022] Open
Abstract
Background Chronic kidney disease (CKD) has become a major public health issue worldwide in the past few years. Pruritus is a common, well-recognized complication often seen in patients with chronic renal failure. For assessment of pruritus, different tools are used but these tools are unable to identify the changes and variations in the severity of pruritus. The aim of our study was to validate the Urdu-version of the Urdu-version of the 5D itch scale among patients suffering from chronic kidney disease in Pakistan. Method The 5D itch scale was translated from English into Urdu following translation guidelines for translation. Face and content validity was determined by a panel of experts and piloted. For retest, the Urdu version of the 5D itch scale was administered at baseline and two weeks. Results A total of 50 participants with end stage renal disease were recruited, and of these, 64% were males. Exploratory factor analysis revealed that the 5D–IS had 2-factor loadings: “Pattern and activity” and “Distribution” with Kaiser–Mayer–Olkin (KMO) = 0.802, Bartlett’s test of sphericity was significant (df = 28, p < 0.001). At test re-test, Cronbach’s alpha was 0.914, while the intra class correlation was 0.9160 (95% confidence interval 0.941–0.975), which is a highly significant correlation (p < 0.0001). Conclusion The Urdu version of the 5D itch scale was found to be a valid and reliable instrument for assessing pruritus and its severity in patients with chronic kidney disease in Pakistan. Electronic supplementary material The online version of this article (10.1186/s12882-017-0717-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Inayat Ur Rehman
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia.
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
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Simonsen E, Komenda P, Lerner B, Askin N, Bohm C, Shaw J, Tangri N, Rigatto C. Treatment of Uremic Pruritus: A Systematic Review. Am J Kidney Dis 2017; 70:638-655. [PMID: 28720208 DOI: 10.1053/j.ajkd.2017.05.018] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/16/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Uremic pruritus is a common and burdensome symptom afflicting patients with advanced chronic kidney disease (CKD) and has been declared a priority for CKD research by patients. The optimal treatments for uremic pruritus are not well defined. STUDY DESIGN Systematic review. SETTING & POPULATION Adult patients with advanced CKD (stage ≥ 3) or receiving any form of dialysis. SELECTION CRITERIA FOR STUDIES PubMed, CINAHL, Embase, International Pharmaceutical Abstracts, Scopus, Cochrane Library, and ClinicalTrials.gov from their inception to March 6, 2017, were systematically searched for randomized controlled trials (RCTs) of uremic pruritus treatments in patients with advanced CKD (stage ≥ 3) or receiving any form of dialysis. 2 reviewers extracted data independently. Risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. INTERVENTION Any intervention for the treatment of uremic pruritus was included. OUTCOMES A quantitative change in pruritus intensity on a visual analogue, verbal rating, or numerical rating scale. RESULTS 44 RCTs examining 39 different treatments were included in the review. These treatments included gabapentin, pregabalin, mast cell stabilizers, phototherapy, hemodialysis modifications, and multiple other systemic and topical treatments. The largest body of evidence was found for the effectiveness of gabapentin. Due to the limited number of trials for the other treatments included, we are unable to comment on their efficacy. Risk of bias in most studies was high. LIMITATIONS Heterogeneity in design, treatments, and outcome measures rendered comparisons difficult and precluded meta-analysis. CONCLUSIONS Despite the acknowledged importance of uremic pruritus to patients, with the exception of gabapentin, the current evidence for treatments is weak. Large, simple, rigorous, multiarm RCTs of promising therapies are urgently needed.
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Affiliation(s)
- Elizabeth Simonsen
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Komenda
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Blake Lerner
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- Seven Oaks Hospital Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Clara Bohm
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
| | - James Shaw
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Claudio Rigatto
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Shirazian S, Aina O, Park Y, Chowdhury N, Leger K, Hou L, Miyawaki N, Mathur VS. Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges. Int J Nephrol Renovasc Dis 2017; 10:11-26. [PMID: 28176969 PMCID: PMC5271405 DOI: 10.2147/ijnrd.s108045] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chronic kidney disease-associated pruritus (CKD-aP) is a distressing, often overlooked condition in patients with CKD and end-stage renal disease. It affects ~40% of patients with end-stage renal disease and has been associated with poor quality of life, poor sleep, depression, and mortality. Prevalence estimates vary based on the instruments used to diagnose CKD-aP, and standardized diagnostic instruments are sorely needed. Treatment studies have often yielded conflicting results. This is likely related to studies that are limited by small sample size, flawed designs, and nonstandardized diagnostic instruments. Several large well-designed treatment trials have recently been completed and may soon influence CKD-aP management.
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Affiliation(s)
- Shayan Shirazian
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY
| | - Olufemi Aina
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY
| | - Youngjun Park
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY
| | - Nawsheen Chowdhury
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY
| | - Kathleen Leger
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY
| | - Linle Hou
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY
| | - Nobuyuki Miyawaki
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY
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Scherer JS, Combs SA, Brennan F. Sleep Disorders, Restless Legs Syndrome, and Uremic Pruritus: Diagnosis and Treatment of Common Symptoms in Dialysis Patients. Am J Kidney Dis 2016; 69:117-128. [PMID: 27693261 DOI: 10.1053/j.ajkd.2016.07.031] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/06/2016] [Indexed: 11/11/2022]
Abstract
Maintenance dialysis patients experience a high burden of physical and emotional symptoms that directly affect their quality of life and health care utilization. In this review, we specifically highlight common troublesome symptoms affecting dialysis patients: insomnia, restless legs syndrome, and uremic pruritus. Epidemiology, pathophysiology, and evidence-based current treatment are reviewed with the goal of providing a guide for diagnosis and treatment. Finally, we identify multiple additional areas of further study needed to improve symptom management in dialysis patients.
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Affiliation(s)
- Jennifer S Scherer
- Division of Palliative Care, NYU School of Medicine, New York, NY; Division of Nephrology, NYU School of Medicine, New York, NY.
| | - Sara A Combs
- Division of Nephrology, Department of Medicine, VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO; Division of Palliative Care, Department of Medicine, VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO
| | - Frank Brennan
- Department of Nephrology, St. George Hospital, Kogarah, New South Wales, Australia
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Efficacy of Topical Application of Sweet Almond Oil on Reducing Uremic Pruritus in Hemodialysis Patients: A Randomized Clinical Trial Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.34695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jiang X, Ji F, Chen ZW, Huang QL. Comparison of high-flux hemodialysis with hemodialysis filtration in treatment of uraemic pruritus: a randomized controlled trial. Int Urol Nephrol 2016; 48:1533-41. [DOI: 10.1007/s11255-016-1364-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/28/2016] [Indexed: 12/24/2022]
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Kim KH, Lee MS, Kim T, Kang JW, Choi T, Lee JD. Acupuncture and related interventions for symptoms of chronic kidney disease. Cochrane Database Syst Rev 2016; 2016:CD009440. [PMID: 27349639 PMCID: PMC8406453 DOI: 10.1002/14651858.cd009440.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND People living with chronic kidney disease (CKD) experience a range of symptoms and often have complex comorbidities. Many pharmacological interventions for people with CKD have known risks of adverse events. Acupuncture is widely used for symptom management in patients with chronic diseases and in other palliative care settings. However, the safety and efficacy of acupuncture for people with CKD remains largely unknown. OBJECTIVES We aimed to evaluate the benefits and harms of acupuncture, electro-acupuncture, acupressure, moxibustion and other acupuncture-related interventions (alone or combined with other acupuncture-related interventions) for symptoms of CKD. In particular, we planned to compare acupuncture and related interventions with conventional medicine, active non-pharmacological interventions, and routine care for symptoms of CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Specialised Register up to 28 January 2016 through contact with the Information Specialist using search terms relevant to this review. We also searched Korean medical databases (including Korean Studies Information, DBPIA, Korea Institute of Science and Technology Information, Research Information Centre for Health Database, KoreaMed, the National Assembly Library) and Chinese databases (including the China Academic Journal). SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs that investigated the effects of acupuncture and related point-stimulation interventions with or without needle penetration that involved six sessions or more in adults with CKD stage 3 to 5, regardless of the language and type of publication. We excluded studies that used herbal medicine or co-interventions administered unequally among the study groups. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed risk of bias. We calculated the mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals (CI) for continuous outcomes and risk ratio (RR) for dichotomous outcomes. Primary outcomes were changes in pain and depression, and occurrence of serious of adverse events. MAIN RESULTS We included 24 studies that involved a total of 1787 participants. Studies reported on various types of acupuncture and related interventions including manual acupuncture and acupressure, ear acupressure, transcutaneous electrical acupuncture point stimulation, far-infrared radiation on acupuncture points and indirect moxibustion. CKD stages included pre-dialysis stage 3 or 4 and end-stage kidney disease on either haemodialysis or peritoneal dialysis.None of the included studies assessed pain outcomes, nor formally addressed occurrence of serious adverse events, although three studies reported three participant deaths and three hospitalisations as reasons for attrition. Three studies reported minor acupuncture-related harms; the remainder did not report if those events occurred.All studies were assessed at high or unclear risk of bias in terms of allocation concealment. Seventeen studies reported outcomes measured for only two months.There was very low quality of evidence that compared with routine care, manual acupressure reduced scores of the Beck Depression Inventory score (scale from 0 to 63) (3 studies, 128 participants: MD -4.29, 95% CI -7.48 to -1.11, I(2) = 0%), the revised Piper Fatigue Scale (scale from 0 to 10) (3 studies, 128 participants: MD -1.19, 95% CI -1.77 to -0.60, I(2) = 0%), and the Pittsburgh Sleep Quality Index (scale from 0 to 21) (4 studies, 180 participants: MD -2.46, 95% CI -4.23 to -0.69, I(2) = 50%).We were unable to perform further meta-analyses because of the paucity of data and problems with clinical heterogeneity, such as different interventions, comparisons and timing of outcome measurements. AUTHORS' CONCLUSIONS There was very low quality of evidence of the short-term effects of manual acupressure as an adjuvant intervention for fatigue, depression, sleep disturbance and uraemic pruritus in patients undergoing regular haemodialysis. The paucity of evidence indicates that there is little evidence of the effects of other types of acupuncture for other outcomes, including pain, in patients with other stages of CKD. Overall high or unclear risk of bias distorts the validity of the reported benefit of acupuncture and makes the estimated effects uncertain. The incomplete reporting of acupuncture-related harm does not permit us to assess the safety of acupuncture and related interventions. Future studies should investigate the effects and safety of acupuncture for pain and other common symptoms in patients with CKD and those undergoing dialysis.
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Affiliation(s)
- Kun Hyung Kim
- School of Korean Medicine, Pusan National UniversityDepartment of Acupuncture & MoxibustionBeom‐eo riMul‐geum eupYangsanKorea, South626‐770
| | - Myeong Soo Lee
- Korea Institute of Oriental MedicineMedical Research Division461‐24 Jeonmin‐dong, Yuseong‐guDaejeonKorea, South305‐811
| | - Tae‐Hun Kim
- College of Korean Medicine, Kyung Hee UniversityKorean Medicine Clinical Trial Center#23 Kyungheedae‐roDongdaemun‐guSeoulKorea, South130‐872
| | - Jung Won Kang
- College of Korean Medicine, Kyung Hee UniversityDepartment of Acupuncture & Moxibustion1, Hoegi‐DongDongdaemun‐GuSeoulKorea, South130‐702
| | - Tae‐Young Choi
- Korea Institute of Oriental MedicineMedical Research Division461‐24 Jeonmin‐dong, Yuseong‐guDaejeonKorea, South305‐811
| | - Jae Dong Lee
- Kyung Hee UniversityDepartment of Acupuncture & Moxibustion, College of Korean MedicineSeoulKorea, South
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Abstract
Pruritus is a common and distressing symptom in patients with chronic kidney disease. The most recent epidemiologic data have suggested that approximately 40% of patients with end-stage renal disease experience moderate to severe pruritus and that uremic pruritus (UP) has a major clinical impact, being associated strongly with poor quality of life, impaired sleep, depression, and increased mortality. The pathogenesis of UP remains largely unclear, although several theories on etiologic or contributing factors have been proposed including increased systemic inflammation; abnormal serum parathyroid hormone, calcium, and phosphorus levels; an imbalance in opiate receptors; and a neuropathic process. UP can present somewhat variably, although it tends to affect large, discontinuous, but symmetric, areas of skin and to be most symptomatic at night. A variety of alternative systemic or dermatologic conditions should be considered, especially in patients with asymmetric pruritus or other atypical features. Treatment initially should focus on aggressive skin hydration, patient education on minimizing scratching, and optimization of the aspects of chronic kidney disease care that are most relevant to pruritus, including dialysis adequacy and serum parathyroid hormone, calcium, and phosphorus management. Data for therapy specifically for UP remain limited, although topical therapies, gabapentin, type B ultraviolet light phototherapy, acupuncture, and opioid-receptor modulators all may play a role.
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Affiliation(s)
- Sara A Combs
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - J Pedro Teixeira
- Department of Medicine, University of Washington Medical Center, University of Washington, Seattle, WA
| | - Michael J Germain
- Department of Medicine, Baystate Medical Center, Tufts University, Springfield, MA.
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Amirkhanlou S, Rashedi A, Taherian J, Hafezi AA, Parsaei S. Comparison of Gabapentin and Ketotifen in Treatment of Uremic Pruritus in Hemodialysis Patients. Pak J Med Sci 2016; 32:22-6. [PMID: 27022338 PMCID: PMC4795872 DOI: 10.12669/pjms.321.8547] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objectives: Uremic pruritus is a common problem in hemodialysis patients. Several treatments have been used for decreasing itching in these patients. Gabapentin and ketotifen are two drugs used for treating uremic patients. The aim of this study was to compare gabapentin and ketotifen in treatment of uremic pruritus in hemodialysis patients. Methods: In this double-blind randomized clinical trial, 52 hemodialysis patients with uremic pruritus referred to 5azarTeaching Hospital in Gorgan in 2013 were studied. Patients were randomly assigned to two groups of 26 subjects (groups G and K). In group G, patients treated with gabapentin capsules 100 mg daily for 2 weeks, and in Group K, patients treated with ketotifen 1 mg twice daily for 2 weeks. Before and at the end of study, pruritus severity was determined based on Shiratori’s severity scores. Collected data were analyzed by SPSS-21 statistical software. Results: There was no significant different between two groups in the age and sex. After two weeks of treatment, severity of pruritus was significantly reduced in both groups (88.4% in group G vs. 76.9% in group K). Gabapentin compared with ketotifen had a better effect on improving itching in the age group of 30-60 years and in males. 5 patients (19.2%) in both groups suffered from drowsiness and dizziness, but no serious side effects were observed. Conclusions: The results showed that gabapentin and ketotifen significantly improved pruritus in hemodialysis patients, and no significant difference was observed between two groups.
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Affiliation(s)
- Saeid Amirkhanlou
- Dr. Saeid Amirkhanlou, MD, Assistant Professor, Nephrologist, Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Anna Rashedi
- Dr. Anna Rashedi, MD, Radiologist, Assistant Professor, Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Jalal Taherian
- Dr. Jalal Taherian, MD, General Practitioner, Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Ali Akbar Hafezi
- Dr. Ali Akbar Hafezi, MD, General Practitioner, Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Sahar Parsaei
- Sahar Parsaei, Medical Student, Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
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Abstract
Chronic itch in the elderly is a common problem, with a significant impact on quality of life and sleep in elderly patients. Chronic itch may be attributable to several causes, including dry skin, immunosenescence and neural degeneration. Itch may also be caused by skin diseases, such as seborrhoeic dermatitis and stasis dermatitis; systemic conditions, such as end-stage renal disease and diabetes; and psychogenic conditions, such as depression and anxiety. The use of polypharmacy may also cause itch, with or without a rash. Specifically, thiazides and calcium channel blockers have been known to cause itch in elderly patients. Management should be tailored according to the underlying dermatological or systemic aetiology of itch. Topical treatment is the mainstay of therapy, providing special emphasis on skin hydration and barrier repair. In addition, topical and oral medications that target the nervous system and reduce neuronal hypersensitization, such as gabapentin and selective antidepressants, have a role in treating patients with severe chronic itch. Furthermore, management must account for changes in metabolism and pharmacokinetics of drugs in the aging population in order to prevent the occurrence of adverse effects.
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Manage chronic pruritus in the elderly with various agents depending on the pathophysiology and aetiology of the condition. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Alternative, Complementary, and Forgotten Remedies for Atopic Dermatitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015. [PMID: 26257817 DOI: 10.1155/2015/676897.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Atopic dermatitis, perhaps more than other dermatologic diseases, has garnered much attention in the realm of alternative medicine. This may be because its etiopathogenesis is incompletely understood, it is increasingly common, and it waxes and wanes often without clear precipitants, opening up many opportunities for misinterpretation. Herein we explore the evidence for a number of different alternative and complementary therapies, from textiles to vitamin supplements. By definition, none have enough data to be deemed "effective" in a conventional sense, but it is hopeful that some show promising evidence that may one day lead to mainstream acceptance with further research.
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Alternative, Complementary, and Forgotten Remedies for Atopic Dermatitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:676897. [PMID: 26257817 PMCID: PMC4518179 DOI: 10.1155/2015/676897] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 06/25/2015] [Indexed: 12/14/2022]
Abstract
Atopic dermatitis, perhaps more than other dermatologic diseases, has garnered much attention in the realm of alternative medicine. This may be because its etiopathogenesis is incompletely understood, it is increasingly common, and it waxes and wanes often without clear precipitants, opening up many opportunities for misinterpretation. Herein we explore the evidence for a number of different alternative and complementary therapies, from textiles to vitamin supplements. By definition, none have enough data to be deemed “effective” in a conventional sense, but it is hopeful that some show promising evidence that may one day lead to mainstream acceptance with further research.
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40
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Efficacy of Acupuncture in Itch: A Systematic Review and Meta-Analysis of Clinical Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:208690. [PMID: 26064156 PMCID: PMC4430643 DOI: 10.1155/2015/208690] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/27/2015] [Accepted: 04/15/2015] [Indexed: 12/11/2022]
Abstract
Background. Itch (pruritus) is a sensitive state that provokes the desire to scratch. It is not only a common symptom of skin diseases but it also occurs in some systemic diseases. Clinical studies on the efficacy of the acupuncture therapy in alleviating itch are increasing, while systematic reviews assessing the efficacy of acupuncture therapy are still lacking. Objective. This systematic review aims to assess the effectiveness of acupuncture therapy for itch. Materials and Methods. A comprehensive literature search of eight databases was performed up to June 2014, and randomized controlled trials which compared acupuncture therapy and placebo acupuncture or no treatment group were identified. Accordingly, a meta-analysis was conducted. Results. This review included three articles of randomized controlled trials (RCTs) from a total of 2530 articles. The results of Meta-analysis showed that acupuncture therapy was effective to alleviate itch compared with placebo acupuncture and no treatment group. Conclusion. Based on the findings of this systematic review, we cautiously suggest that acupuncture therapy could improve the clinical efficacy of itch. However, this conclusion needs more studies on various ethnic samples to confirm our final conclusion.
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Jin DH, Shen HY, Feng S, Zhan ZB, Jiang LS, Qiu BF, Zeng Y, Shi YB. Treatment Effects of Different Incident Dialysis Modalities on Pruritus in Elderly Uremic Patients. INT J GERONTOL 2014. [DOI: 10.1016/j.ijge.2014.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Mcculloch M, Nachat A, Schwartz J, Casella-Gordon V, Cook J. Acupuncture safety in patients receiving anticoagulants: a systematic review. Perm J 2014; 19:68-73. [PMID: 25432001 DOI: 10.7812/tpp/14-057] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Theoretically, acupuncture in anticoagulated patients could increase bleeding risk. However, precise estimates of bleeding complication rates from acupuncture in anticoagulated patients have not been systematically examined. OBJECTIVE To critically evaluate evidence for safety of acupuncture in anticoagulated patients. METHODS We searched PubMed, EMBASE, the Physiotherapy Evidence Database, and Google Scholar. RESULTS Of 39 potentially relevant citations, 11 met inclusion criteria: 2 randomized trials, 4 case series, and 5 case reports. Seven provided reporting quality sufficient to assess acupuncture safety in 384 anticoagulated patients (3974 treatments). Minor-moderate bleeding related to acupuncture in an anticoagulated patient occurred in one case: a large hip hematoma, managed with vitamin K reversal and warfarin discontinuation following reevaluation of its medical justification. Blood-spot bleeding, typical for any needling/injection and controlled with pressure/cotton, occurred in 51 (14.6%) of 350 treatments among a case series of 229 patients. Bleeding deemed unrelated to acupuncture during anticoagulation, and more likely resulting from inappropriately deep needling damaging tissue or from complex anticoagulation regimens, occurred in 5 patients. No bleeding was reported in 2 studies (74 anticoagulated patients): 1 case report and 1 randomized trial prospectively monitoring acupuncture-associated bleeding as an explicit end point. Altogether, 1 moderate bleeding event occurred in 3974 treatments (0.003%). CONCLUSION Acupuncture appears to be safe in anticoagulated patients, assuming appropriate needling location and depth. The observed 0.003% complication rate is lower than the previously reported 12.3% following hip/knee replacement in a randomized trial of 27,360 anticoagulated patients, and 6% following acupuncture in a prospective study of 229,230 all-type patients. Prospective trials would help confirm our findings.
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Affiliation(s)
- Michael Mcculloch
- Research Lead for Integrative Medicine at the Walnut Creek Hospital in CA and a Research Chief at the Pine Street Foundation in San Anselmo, CA.
| | - Arian Nachat
- Director of Integrative Medicine at the Walnut Creek Hospital in CA.
| | - Jonathan Schwartz
- Research Intern in Integrative Medicine at the Walnut Creek Hospital in CA.
| | - Vicki Casella-Gordon
- Clinical Nurse Specialist in Integrative Medicine at the Walnut Creek Hospital in CA.
| | - Joseph Cook
- Research Intern in Integrative Medicine at the Walnut Creek Hospital in CA.
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Tsai KS, Chen YH, Chen HY, Shen EY, Lee YC, Shen JL, Wu SY, Lin JG, Chen YH, Chen WC. Antipruritic effect of cold stimulation at the Quchi acupoint (LI11) in mice. Altern Ther Health Med 2014; 14:341. [PMID: 25239797 PMCID: PMC4179855 DOI: 10.1186/1472-6882-14-341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 09/16/2014] [Indexed: 12/15/2022]
Abstract
Background Acupuncture and moxibustion are used to treat pruritus and atopic dermatitis. However, whether cold stimulation (defined as that the temperature conducted under skin temperature) of acupoints affects itching in experimental murine models remains unclear. Methods The present study was designed to determine the therapeutic effects of different thermal stimulations at the Quchi acupoint (LI11) in a murine model in which scratching behaviour was elicited by subcutaneous injection with a pruritogenic agent (compound 48/80). Male ICR mice were divided into several groups as follows: control (saline), those receiving compound 48/80 and compound 48/80 with various thermal stimulations (5°C–45°C) at LI11 (n = 6 per group). The scratch response of each animal to these stimulations was recorded for 30 min. The antipruritic effect of the acupoint was further evaluated in LI11 and sham (non-acupoint) groups (n = 6 per group). Results Treatment with lower temperature (20°C) at the LI11 acupoint significantly attenuated compound 48/80-induced scratching; however, this antipruritic effect was not observed with stimulation at the sham point. The expression of c-fos in the neuron of the cervical spine induced by compound 48/80 was suppressed by cold stimulation at LI11. The antipruritic effect of cold stimulation was blocked by ruthium red (RR), a non-selective transient receptor potential (TRP) channel blocker, suggesting that TRP channels may play an important role in the antipruritic effect of cold stimulation at LI11 in mice. Conclusions This study demonstrated that cold stimulation at LI11 attenuated compound 48/80-induced scratching behaviour in mice, possibly by a TRP-related pathway.
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Ernst E, Lee MS. Do randomised studies of traditional Asian therapies generate different results than non-randomised trials? Int J Clin Pract 2014; 68:655-7. [PMID: 24750528 DOI: 10.1111/ijcp.12417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- E Ernst
- Complementary Medicine, Peninsula Medical School, University of Exeter, Exeter, UK.
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