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Titolo Uremic Pruritus, Dialysis Adequacy, and Metabolic Profiles in Hemodialysis Patients: A Prospective 5-Year Cohort Study
Autore Mei-Ju Ko1,4,6., Hon-Yen Wu2,5,7., Hung-Yuan Chen2,5, Yen-Ling Chiu2,5, Shih-Ping Hsu2,5, Mei-Fen Pai2,5, Ju-YehYang2,5, Chun-Fu Lai2,5, Hui-Min Lu3, Shu-Chen Huang3, Shao-Yu Yang2,5, Su-Yin Wen1, Hsien-Ching Chiu4, Fu-Chang Hu6,8, Yu-Sen Peng2,5*", Shiou-Hwa Jee4*" - 1 Department of Dermatology, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan, 2 Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, 3 Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan, 4 Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, 5 Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, 6 Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan, 7 Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan, 8 School of Nursing, National Taiwan University, Taipei, Taiwan
Referenza PLoS ONE 2013; 8(8): e71404
Contenuto

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.

Data 11.03.2014
 
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