Teach You 6 Tricks To Deal With Itchy Skin in Dialysis Patients
Aug 22, 2022
Although pruritus is only one aspect that affects the quality of life of hemodialysis patients, once it occurs, it is painful. How to effectively intervene against pruritus symptoms in dialysis patients? Professor Liu Jian from the Nephrology Center of the First Affiliated Hospital of Xinjiang Medical University shared this at the 2021 academic annual meeting of the Chinese Medical Association Nephrology Branch.
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How much do you know about itching in dialysis patients?
The prevalence of pruritus in dialysis patients can reach 63% to 84%, and it is known to be associated with dryness, altered mineral metabolism, iron-deficiency anemia, infection, and inflammation [1], and can lead to significantly reduced quality of life, depression, sleep Adverse outcomes such as poor quality and increased mortality.
Overall, pruritic episodes in dialysis patients were mainly associated with the following etiologies:
Metabolic disorders lead to the accumulation of various toxins in the body (parathyroid hormone, histamine, tryptase, xenobiotics, aluminum, magnesium, calcium, phosphorus, cytokines, and inflammatory factors);
Central neuropathy (opioid receptor imbalance, psychological factors);
Local lesions of the skin (xerosis, dermatitis);
Peripheral neuropathy (dysfunction of peripheral receptors, sensorimotor or autonomic neuropathy);
Immune dysfunction (micro-inflammation of the skin, allergies, etc.).
According to the Dialysis Outcomes and Practice Patterns Study (DOPPS) data, the incidence of pruritus symptoms did not improve very well either in terms of time span or geographic breadth.
How to assess pruritus in dialysis patients?
In the assessment, a visual analog scale (VAS), questionnaires, and image recordings can be used for management [4]. The recording method can use schematic diagrams of body parts to record the location and changes of itching.
Studies have shown that when the Kt/V of hemodialysis patients is less than 1.5, the pruritus score begins to increase gradually. Therefore, in treating pruritus, it is first necessary to consider improving the quality of dialysis, improving Kt/V, Ca, P and parathyroid hormone, etc. index.
However, according to the pathophysiology of pruritus in dialysis patients, hemodialysis itself may lead to pruritus. Obviously, improving the quality of dialysis is not the only means.
Prospective or committed treatment options exist for each link because the mechanisms of pruritus may be related to mast cell activation, dysregulated skin cell signaling, and various nociceptor-induced pruritus in the peripheral and central nervous systems.
How to treat and improve itching in dialysis patients?
① Studies have shown that 15% glycerol + 10% paraffin emulsifier can be used to improve itching caused by dry skin in dialysis patients [7].
②The treatment principle of topical therapy is to relieve itching and skin care. In addition to topical antipruritic drugs and topical immunosuppressants, attention should be paid to wearing cotton underwear, promoting warm water baths and using fragrance-free emollients.
③ If it is judged that allergies cause itching, antihistamine allergy drugs with better efficacy and relatively safe can be used. At the same time, there are some systemic antipruritic drugs available, such as gabapentin and pregabalin, but the side effects that may lead to disturbance of consciousness and falls need to be prevented [8].
④ If pruritus is considered to be related to mental or mood disorders, and the patient suffers from depression or insomnia as a result, mirtazapine can be used for treatment.
⑤ If the itching symptoms caused by hypercalcemia are difficult to improve by conventional calcium-lowering methods, the experience of intravenous injection of sodium thiosulfate in the Aerospace Center Hospital can be used for reference, which may also be related to the anti-allergic effect of sodium thiosulfate [ 9].
⑥ As for acupuncture, psychological intervention, and exercise, diagnosis and treatment intervention must be carried out under the guidance of professionals.
Summarize
Professor Liu Jian pointed out that the serious incidence of pruritus in dialysis patients is very high at present, which seriously affects the quality of life of patients. Therefore, pruritus treatment should be one of the basic skills of dialysis doctors.
The best treatment mode for pruritus is the "biological-psycho-social" trinity, and the diagnosis of etiology must be emphasized in the treatment. It should be pointed out that dialysis efficiency is the basis of other treatments (moisturizing skin care, topical medicine, phototherapy, and acupuncture, etc.), in addition, anti-allergic drugs and gabapentin are commonly used first-line antipruritic drugs. In recent years, opioid receptor agonists/inhibitors have also gradually become available.
