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Pruritus
Etiology
Common abnormalities in ESRD play a role in pathogenesis:
Xerosis (dry skin)
Peripheral neuropathy
Hypercalcemia
Hyperphosphatemia
Hypermagnesemia
Zinc depletion
Hypervitaminosis A
No correlation found between standard biochemical tests (blood urea nitrogen, creatinine, calcium, phosphate, parathyroid hormone) and uremic pruritus2
A possible role for chronic inflammation3
A possible relationship between pruritus and type of dialyzer is not clear4
Other modalities: Acupuncture, electric needle stimulation and sauna, parathyroidectomy and renal transplantation in recalcitrant cases
Prevention
Optimizing calcium, phosphate, magnesium, PTH and delivered dose of dialysis (greatly reduced at Kt/V > 1.59)
Avoidance of dialysis related factors10 such as iodine, ethylene oxide. Find out any allergy to heparin.
Biocompatible membrane can be used preferably
Consider parathyroidectomy. Renal transplantation is the only definitive treatment.
References:
Lugon JR. Uremic pruritus: A review. Hemodial Int 9:180-188, 2005
Virga G, Mastrosimone S, Amici G, Munaretto G, Gastaldon F, Bonadonna A. Symptoms in hemodialysis patients and their relationship biochemical and demographic parameters. Int J Artif Organs 21:788-793, 1998
Kimmel M, Alscher DM, Dunst R, Braun N, Machleidt C, Kiefer T, Stulten C, van der KH, Pauli-Magnus C, Raub U, Kuhlmann U, Mettang T. The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients. Nephrol Dial Transplant 21:749-755, 2006
Rollino C, Goitre M, Piccoli G, Puiatti P, Martina G, Formica M, Quarello F, Bernengo MG. What is the role of sensitization in uremic pruritus? Nephron 57: 319-322, 1991
Schwartz IF, Iaina A. Management of uremic pruritus. Semin Dial 13:177-180, 2000
Urbonas A, Schwartz RA, Szepietowski JC. Uremic pruritus-an update. Am J Nephrol 21:343-350, 2001
Rosner MH. Cromolyn sodium: A potential therapy for uremic pruritus? Hemodial Int 10:189-192, 2006
Manenti L, Vaglio A. Gabapentin for uraemic pruritus
232. Nephrol Dial Transplant 20:1278-1279, 2005
Masi CM, Cohen EP. Dialysis efficacy and itching in renal failure. Nephron 62: 257-261, 1992
Kessler M, Moneret-Vautrin DA, Cao-Huu T, Mariot A, Chanliau J. Dialysis pruritus and sensitization. Nephron 60:241-251, 1992
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