Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients
Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients
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DOI：
10.1038/sj.ki.5000251
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发表时间：
2006-05-01
影响因子：
19.6
通讯作者：
Gejyo, F
中科院分区：
文献类型：
--
作者：
Narita, I;Alchi, B;Gejyo, F
虽然众所周知，尿毒症是引起瘙痒的最常见原因，但慢性血液透析患者瘙痒的机制仍不清楚。目的是更详细地描述尿毒症瘙痒的特征，并调查严重瘙痒是否是预后不良的标志。对1773例成人血液透析患者进行了研究。每个患者都得到了一份问卷，以评估强度和频率，以及与瘙痒相关的睡眠障碍。我们分析了临床和实验室数据与血液透析患者瘙痒严重程度的关系，并前瞻性地对其进行了24个月的随访。总共有453名患者有严重的瘙痒，视觉模拟评分(VAS)大于或等于7.0。其中，超过70%的患者抱怨睡眠障碍，而VAS评分低于7.0的大多数患者没有睡眠障碍。男性、高水平的血尿素氮、β2-微球蛋白(β2-MG)、高钙血症和高磷血症被确定为严重瘙痒的独立危险因素，而低钙水平和完整甲状旁腺激素水平与风险降低相关。随访期间死亡171例(9.64%)。严重瘙痒患者的预后明显差于其他患者。此外，即使在调整了包括糖尿病、年龄、β2微球蛋白和白蛋白在内的其他临床因素后，严重瘙痒仍与死亡独立相关。严重的尿毒症瘙痒是由多种因素引起的，不仅影响慢性血液透析患者的生活质量，而且可能与预后不良有关。
Although uremia is well known as the most common cause of pruritus, the mechanisms of pruritus in chronic hemodialysis patients remain unclear. The purpose was to characterize uremic pruritus in more detail and to investigate whether severe pruritus is a marker for poor prognosis. A total of 1773 adult hemodialysis patients were studied. A questionnaire was given to each patient to assess the intensity and frequency, as well as pruritus-related sleep disturbance. We analyzed the relationship between clinical and laboratory data and the severity of pruritus in hemodialysis patients and followed them for 24 months prospectively. In total, 453 patients had severe pruritus with a visual analogue scale (VAS) score more than or equal to 7.0. Among them, more than 70% complained of sleep disturbance, whereas the majority of patients with a VAS score of less than 7.0 had no sleep disturbance. Male gender, high levels of blood urea nitrogen, beta 2-microglobulin (beta 2MG), hypercalcemia, and hyperphosphatemia were identified as independent risk factors for the development of severe pruritus, whereas a low level of calcium and intact-parathyroid hormone were associated with reduced risk. During the follow-up, 171 (9.64%) patients died. The prognosis of patients with severe pruritus was significantly worse than the others. Moreover, severe pruritus was independently associated with death even after adjusting for other clinical factors including diabetes mellitus, age, beta 2MG, and albumin. Severe uremic pruritus caused by multiple factors, not only affects the quality of life but may also be associated with poor outcome in chronic hemodialysis patients.