Uremic pruritus in chronic hemodialysis patients.
Uremic pruritus in chronic hemodialysis patients.
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DOI：
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发表时间：
2008-03
影响因子：
3.4
通讯作者：
I. Narita;S. Iguchi;K. Omori;F. Gejyo
中科院分区：
文献类型：
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作者：
I. Narita;S. Iguchi;K. Omori;F. Gejyo
50%-90%接受腹膜透析或血液透析的患者会出现皮肤瘙痒（瘙痒），症状从局部轻微到全身严重不等。在与终末期肾病相关的皮肤病学异常中，瘙痒是最常见的。在所有全身性疾病中，尿毒症是引起瘙痒的最重要原因。尿毒症瘙痒症的机制尚不清楚：继发性甲状旁腺功能亢进、二价离子异常、组胺、过敏性致敏、皮肤肥大细胞增殖、缺铁性贫血、神经病变和神经系统变化，或这些因素的组合。严重的瘙痒不仅影响生活质量，还与慢性血液透析患者的不良预后相关。目前尚无针对尿毒症瘙痒症的特异性、有效的治疗方法。需要进一步的研究来评估新型卡帕阿片激动剂纳芙拉芬的长期疗效和安全性。建议对尿毒症瘙痒症进行早期诊断和治疗，重点关注一般策略，包括优化透析剂量、红细胞生成刺激剂和继发性甲状旁腺功能亢进症的治疗。
Skin itching (pruritus) affects 50%-90% of patients undergoing peritoneal dialysis or hemodialysis and the symptoms range from localized and mild to generalized and severe. Among the dermatological abnormalities associated with end-stage renal disease, pruritus is the most prevalent. Of all systemic disorders, uremia is the most important cause of pruritus. The mechanism underlying uremic pruritus is poorly understood: secondary hyperparathyroidism, divalent-ion abnormalities, histamine, allergic sensitization, proliferation of skin mast cells, iron-deficiency anemia, neuropathy and neurological changes, or a combination of these have been hypothesized. Severe pruritus not only affects the quality of life but is also associated with poor outcome in chronic hemodialysis patients. No specific, effective treatment is currently available for uremic pruritus. Further studies are necessary to evaluate the long-term efficacy and safety of a novel kappa-opioid agonist, nalfurafine. Early diagnosis and treatment of uremic pruritus focusing on general strategies that include the optimization of dialysis dose, erythropoiesis-stimulating agents, and management of secondary hyperparathyroidism is recommended.