Comparison of cutaneous manifestations in chronic kidney disease with or without dialysis

Abstract

Purpose: To study and compare dermatological manifestations in patients with various stages of chronic kidney disease (CKD) and end stage renal disease (ESRD), undialysed and dialysed, in a developing country.

Study design: 200 patients were recruited, 50 each in stages 3, 4 and 5 CKD (undialysed) and 50 in stage 5 undergoing maintenance haemodialysis (MHD) for at least 1 month. Patients in stages 3 and 4 constituted pre-ESRD while stage 5 (both dialysed and undialysed) formed the ESRD group. Detailed cutaneous examination was done for all patients and dermatological manifestations were compared among various study groups.

Results: 96% of patients had at least one dermatological manifestation. Xerosis was most common and was observed in 72% of patients, followed by pigmentation (50%), pruritus (36%), infections (29%), markers of skin ageing (13%), half-and-half nail (28%), and absent lunula (22%). Perforating disorders (3%), bullous disorders (2%), and nephrogenic systemic fibrosis (1%) were encountered less often. Local complications of dialysis occurred in 64% patients on MHD. Diffuse pigmentation and skin pallor were seen more commonly as compared to findings reported in the west. The frequency of most cutaneous manifestations was similar between dialysed and undialysed patients with ESRD. Xerosis, pigmentation, and pruritus were more frequent in patients with severe disease, and mean duration of disease was significantly higher for patients with pigmentation, pruritus, and half-and-half nail. Longer duration on MHD was associated with greater pigmentation and pruritus.

Conclusion: Dermatological manifestations increase with increasing duration and severity of renal disease. Dialysis may in turn often perpetuate many of these cutaneous complaints. Recognition and management of some of these dermatological manifestations may vastly reduce the morbidity and improve the cutaneous outcome in these patients.