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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Itching in nondialyzed uremic subjects and patients on dialysis remains incompletely explained and poorly treated. We evaluated our chronic hemo- and peritoneal dialysis patients for this symptom and synthetically reviewed previous reports on itching and renal failure. We found no biochemical correlates of itching but did find that itching was less with better dialysis as defined by urea kinetic modelling. We conclude that improved dialysis techniques will continue to reduce the prevalence of itching in end-stage renal disease patients.
Nephron 1992
PMID:Dialysis efficacy and itching in renal failure. 143 34

The number of mast cells in the skin was evaluated in 25 patients with end-stage renal failure on different treatment modality (conservative, hemodialysis and peritoneal dialysis). According to the presence of pruritus, uremic patients were divided into two groups: group A, 13 patients with diffuse pruritus, and group B, 12 patients without pruritus. Controls were 6 age- and sex-matched healthy subjects. In comparison with patients without pruritus, patients with pruritus had mainly degranulated, diffusely spread and more numerous mast cells in the skin; significantly higher levels of plasma middle molecular weight substances, serum histamine and PTH and significantly lower serum iron levels. However, no differences were noted in observed parameters between groups on different treatment modalities. Favorable therapeutic effects in patients with pruritus were achieved either with iron supplementation in those with hypoferremia or with antihistamines, mast cell membrane stabilizers and high-permeability membranes.
Nephron 1992
PMID:Uremic pruritus and skin mast cells. 152 40

Patch tests were carried out to evaluate the presence of a sensitization to some components of dialytic circuits in 17 uremic patients complaining of pruritus of unknown origin. Fragments of different dialyzer membranes, of tubing sets, of dialyzer membranes recently resterilized with ethylene oxide and the International Contact Dermatitis Research Group standard series substances were tested. Neither patients nor healthy subjects reacted positively to patch tests, which leads us to question the role of contact allergy in the determination of uremic pruritus.
Nephron 1991
PMID:What is the role of sensitization in uremic pruritus? An allergologic study. 155 14

Somatic symptoms are common in patients on dialysis. Their causes are largely unknown and their therapy is unsatisfactory. To examine the relationship of psychological and clinical factors to these symptoms, 191 interviews were done in patients on hemo- and peritoneal dialysis. The severity of 8 somatic symptoms (tiredness, sleep disturbance, cramps, pruritus, headache, nausea, dyspnea, joint pain) of importance in dialysis patients was measured using previously validated scales. Indices of affect and quality of life were obtained, as was demographic, clinical and laboratory information. The severity of each symptom was significantly related to the indices of affect and quality of life. Using multiple logistic regression, poor affect score was the strongest correlate of each of the following somatic symptoms, tiredness, pruritus, sleep disturbance and cramps. It was ahead of any clinical or demographic variable and was also significantly correlated with the severity of the other symptoms. Indices of hyperparathyroidism were significantly associated with headache, joint pain, dyspnea and nausea. We conclude that the strongest correlate of common somatic symptoms in dialysis patients is affect disturbance, and that therapy aimed at improving the affect may improve the symptoms.
Nephron 1990
PMID:Clinical and psychological correlates of somatic symptoms in patients on dialysis. 235 74

Symptoms were evaluated in 13 haemodialysis patients at dialysate temperatures between 37 and 35 degrees C. After a control period at 37 degrees C (stage 1) dialysate flow rate was increased from 300 ml/min in half the patients but no change in temperature was made (stage 2). In stage 3 dialysate temperature was reduced to 36.5 degrees C and in stage 4 to 35 degrees C. Blood pressure and temperature were measured pre- and post dialysis and patient completed a questionnaire indicating if they experienced any of nine specified symptoms: itch, restless legs, nausea, vomiting, headache, cramp, lethargy, hypotension and change in temperature. Trial stages were compared with chi 2 analysis using Yates correction. Symptoms per dialysis fell from 1.11 to 0.71 between stage 1 and 2 (p less than 0.0005). This was considered to be a trial effect. There was no further significant improvement in symptoms overall as the temperature was reduced to 35 degrees C. However, if complaints of coldness are excluded, there was a progressive reduction in symptoms from stage 1 to stage 4. Dialysate flow rate did not affect symptom reporting. There was no effect on body core temperature or blood pressure due to cool dialysate. Our results suggest there may be some benefit in lowering the dialysate temperature but this is small in relation to the placebo effect. Caution must be used in assessing similar studies using small numbers of dialyses.
Nephron 1989
PMID:Assessment of the symptomatic benefit of cool dialysate. 266 42

Nonspecific symptoms are common in dialysis patients but few methods are available to measure their severity and their response to alteration in dialysis therapy. To determine the clinical features and measure the severity of the most important symptoms in end-stage renal disease (ESRD) patients, 97 dialysis patients were interviewed, 63 of whom were reinterviewed 1 year later. For comparison 82 transplant recipients were also interviewed. The six most important symptoms in dialysis patients (using the product of the patient's perception of severity and prevalence) were tiredness, cramps, pruritus, dyspnea, headaches and joint pain. The symptoms were long-standing, occurred frequently, with little difference in prevalence between hemo- and peritoneal dialysis patients, and were often unrelated to a hemodialysis session. For each symptom, several dimensions of severity were assessed including frequency, duration, effect on sleep, daily living, activity, subjective quality of life and necessity for drug therapy. Often these dimensions did not correlate with patient's perception of severity. For each symptom these items were combined to give an aggregate score with a range 0-10. Interobserver reproducibility for each symptom score was greater than or equal to 0.7 but intraobserver reproducibility was poor for 3 symptoms, because of the fluctuating nature of the symptoms. Construct validity was demonstrated by finding a significantly worse distribution of aggregate scores for tiredness, cramps, pruritus, dyspnea and nausea/vomiting in dialysis compared to transplant patients. Aggregate scores changed little after 1 year's follow-up in stable dialysis patients but significant improvement in the aggregate scores for tiredness, dyspnea and nausea/vomiting were observed in 14 patients after successful transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephron 1988
PMID:Clinical features and severity of nonspecific symptoms in dialysis patients. 306 60

A multiple crossover research study was used to evaluate the effect of dialyzer re-use on fever, blood leaks, serum urea and creatinine values and symptoms. Each of 6 crossover periods consisted of 4 weeks on either single-use or re-use, 1 week washout, 4 weeks on the alternative treatment and 1 week washout. The re-use consisted of 6 uses of each dialyzer and the washout weeks consisted of 3 single-use sessions. Analysis of paired observations within rather than between patients showed no effects of time (i.e. among crossover periods 1 through 6) or number of re-uses (i.e. among uses 1 through 6). There was no significant difference for temperature change during dialysis, blood leak rate, or the serum urea and creatinine values before the first dialysis of each washout period. There were no differences for symptoms of pruritus, cramps, nausea, headache, chest pain, backache or fatigue. There were no clinical advantages or disadvantages associated with dialyzer re-use.
Nephron 1988
PMID:Dialyzer re-use--a multiple crossover study with random allocation to order of treatment. 307 Apr 14

Six patients with intractable uremic pruritus were treated with a modified acupuncture technique, the electrical needle stimulation (ENS). Results were followed with a pruritic score scale based on severity, frequency and distribution of itching, together with sleeping hours and waking up at night. The results were encouraging: pruritus was drastically improved during or after ENS in several patients. A control treatment with superficial electrical stimulation was ineffective.
Nephron 1987
PMID:Electrical needle therapy of uremic pruritus. 350 Apr 24

Inorganic sulfate concentrations are markedly elevated in patients with chronic renal failure (CRF). During hemodialysis, sulfate is removed and circulating levels drop significantly, while chloride concentrations remain relatively constant. We measured sulfate and chloride in sweat from CRF patients collected by pilocarpine iontophoresis. Sweat sulfate concentrations in uremic patients were significantly increased (404 +/- 43 vs. 105 +/- 6 microM in 22 controls). The correlation between plasma and sweat SO4 concentrations in CRF patients was significant (r = 0.77, P less than 0.01). However, the fractional excretion of sulfate in sweat (the sweat/serum ratio) was close to that of chloride (0.26 +/- 0.01 vs. 0.19 +/- 0.02) and was essentially the same before and after dialysis (0.20 +/- 0.01 vs 0.23 +/- 0.01) despite the significant absolute change in the extracellular SO4 concentration (from 2,018 +/- 153 to 709 +/- 21 microM) and no change in chloride concentrations. In patients with CRF, we conclude that the handling of inorganic sulfate by the sweat gland is not significantly different from that for chloride. Hemodialysis reduces absolute sulfate excretion markedly and thus may reduce the likelihood of forming calcium sulfate complexes in the sweat secretions. This could be a significant factor in the dialysis-related pruritus that has been ascribed to excess calcium deposition in the skin.
Nephron 1986
PMID:Increased sweat sulfate concentrations in chronic renal failure. 377 82

94 uremic patients, 68 on regular hemodialysis treatment (RHT) and 26 on chronic ambulatory peritoneal dialysis (CAPD), were followed for up to 20 months in search of dermatological manifestations. 79% of RHT and 76% of CAPD patients had some kind of cutaneous lesion. The most characteristic features of cutaneous involvement in RHT and CAPD patients were: cutaneous xerosis, pruritus, infectious manifestations and disorders of pigmentation. In 4 RHT patients, precancerous and cancerous manifestations were also observed.
Nephron 1985
PMID:Cutaneous abnormalities in uremic patients. 401 Aug 46


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