Uremic Pruritus, Dialysis Adequacy, and Metabolic Profiles in Hemodialysis Patients: A Prospective 5-Year Cohort Study
Journal
PLoS ONE
Journal Volume
8
Journal Issue
8
Pages
e71404
Date Issued
2013
Author(s)
Ko M.-J.
Wu H.-Y.
Chen H.-Y.
Chiu Y.-L.
Hsu S.-P.
Pai M.-F.
Lai C.-F.
Huang S.-C.
Yang S.-Y.
Chiu H.-C.
Peng Y.-S.
Peng Y.-S.
Jee S.-H.
Abstract
Background:Uremic pruritus is a common and intractable symptom in patients on chronic hemodialysis, but factors associated with the severity of pruritus remain unclear. This study aimed to explore the associations of metabolic factors and dialysis adequacy with the aggravation of pruritus.Methods:We conducted a 5-year prospective cohort study on patients with maintenance hemodialysis. A visual analogue scale (VAS) was used to assess the intensity of pruritus. Patient demographic and clinical characteristics, laboratory parameters, dialysis adequacy (assessed by Kt/V), and pruritus intensity were recorded at baseline and follow-up. Change score analysis of the difference score of VAS between baseline and follow-up was performed using multiple linear regression models. The optimal threshold of Kt/V, which is associated with the aggravation of uremic pruritus, was determined by generalized additive models and receiver operating characteristic analysis.Results:A total of 111 patients completed the study. Linear regression analysis showed that lower Kt/V and use of low-flux dialyzer were significantly associated with the aggravation of pruritus after adjusting for the baseline pruritus intensity and a variety of confounding factors. The optimal threshold value of Kt/V for pruritus was 1.5 suggested by both generalized additive models and receiver operating characteristic analysis.Conclusions:Hemodialysis with the target of Kt/V ?1.5 and use of high-flux dialyzer may reduce the intensity of pruritus in patients on chronic hemodialysis. Further clinical trials are required to determine the optimal dialysis dose and regimen for uremic pruritus. ? 2013 Ko et al.
SDGs
Other Subjects
alanine aminotransferase; albumin; alkaline phosphatase; aspartate aminotransferase; bilirubin; C reactive protein; calcium; cholesterol; ferritin; glucose; parathyroid hormone; adult; albumin blood level; article; artificial kidney; calcium blood level; change score; clinical laboratory; cohort analysis; demography; diet restriction; disease association; disease course; disease severity; enzyme blood level; female; ferritin blood level; follow up; hematocrit; hemodialysis patient; human; leukocyte count; linear regression analysis; longitudinal study; maintenance therapy; major clinical study; male; metabolism; prospective study; pruritus; rating scale; receiver operating characteristic; risk factor; scoring system; treatment duration; uremia; uremic pruritus; visual analog scale; Aged; Cohort Studies; Female; Humans; Male; Metabolome; Middle Aged; Pruritus; Renal Dialysis; Research Design; Severity of Illness Index; Uremia
Type
journal article