Clinical characteristics of uremic pruritus in patients undergoing haemodialysis

Abstract

Objective: To document various characteristics of uremic pruritus in patients undergoing haemodialysis.

Design: Case series.

Place and duration of study: This study was carried out at Sindh Institute of Urology, Karachi, and Departments of Dermatology and Medicine, PNS Shifa, Karachi, over a period of 3 months.

Patients and methods: One hundred patients of end stage renal disease undergoing haemodialysis were studied. Characteristics of pruritus like occurrence, duration, appearance, intensity, distribution, areas of maximum intensity, relationship to HCV status, effect on mood and sleep were documented. Effect of rest, dry skin, heat, sweat, clothing, cold, tiredness, dialysis, medications, application of lubricants and association of pruritus with different laboratory parameters was also noted. A comprehensive proforma was used to collect the data.

Results: Pruritus appeared within 2-3 months of start of dialysis in 75%. It occurred daily in 83%, weekly in 11% and monthly in 6%. It was intermittent in 45%, all day in 32%, and exacerbated at night in 23%. It was mild in 48%, moderate in 17%, severe in 27% and intractable in 8%. Areas of maximum intensity were legs (60%) and back (30%), 55% had sleep problems, 21% became agitated, while 11% became depressed. Dry skin and cold environment exacerbated while rest and hot environment ameliorated pruritus. Patients with pruritus did not differ from those without it with regard to laboratory parameters or use of medication.

Conclusion: This study gives us a comprehensive characterization of uremic pruritus which may be a useful guideline for the treating physician.