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. 2014 Aug 25:7:329-35.
doi: 10.2147/IJNRD.S65929. eCollection 2014.

B-type (brain) natriuretic peptide and pruritus in hemodialysis patients

Yoshio Shimizu  1 , Ayano Sonoda  1 , Chieko Nogi  1 , Yoko Ogushi  1 , Reo Kanda  1 , Saori Yamaguchi  1 , Nao Nohara  1 , Tatsuya Aoki  1 , Kaori Yamada  1 , Junichiro Nakata  1 , Hiroaki Io  1 , Atsushi Kurusu  1 , Chieko Hamada  1 , Satoshi Horikoshi  1 , Yasuhiko Tomino  1
Affiliations

B-type (brain) natriuretic peptide and pruritus in hemodialysis patients

Yoshio Shimizu et al. Int J Nephrol Renovasc Dis. .

Abstract

Introduction and objective: While pruritus is a common complication in hemodialysis patients, the pathophysiological mechanisms remain obscure. Recently, B-type (brain) natriuretic peptide (BNP) has been defined as an itch-selective neuropeptide in pruriceptive neurons in mice, and higher serum levels of BNP are frequently observed in hemodialysis patients. The objective of the present study was to evaluate the role of serum BNP in pruritus in patients undergoing hemodialysis.

Patients and methods: The current cross-sectional study was performed on 43 patients undergoing maintenance hemodialysis. A visual analog scale (VAS) measuring the general severity of pruritus (values from 0 to 10, with higher values indicating more severe pruritus) in daytime and at night was self-reported by patients. Each patient's background and laboratory tests, including serum BNP in the post-hemodialysis period, were collected. The correlation between VAS and clinical parameters was evaluated.

Results: Both daytime and nighttime VAS scores in diabetic patients were significantly less than those in nondiabetic patients. Multiple regression analysis revealed that pruritus in daytime was worsened by serum BNP (β=2.0, t=2.4, P=0.03), calcium (β=4.4, t=5.2, P<0.0001), and β2-microglobulin (β=2.0, t=3.0, P=0.007), while it was eased by age (β=-2.2, t=-3.2, P=0.0004). Nocturnal pruritus was severe in nondiabetic patients (β=1.7, t=3.8, P=0.0005) and weakened by the total iron binding capacity (β=-2.9, t=-3.1, P=0.004).

Conclusion: It is suggested that a higher level of serum BNP increases the pruritus of hemodialysis patients in daytime and that diabetic patients are less sensitive to itch, especially at nighttime.

Keywords: B-type brain natriuretic peptide; cerebrospinal fluid; hemodialysis; itch-selective neuropeptide; pruriceptive neurons; pruritus; visual analog scale.

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Figures

Figure 1
Figure 1
Impact of serum BNP on pruritus severity. Notes: Hemodialysis patients with DM and without DM (non-DM) were compared with VAS at daytime (A) and nighttime (B). Both daytime and nighttime VAS scores in DM patients were significantly lower than in non-DM patients (*P<0.05, **P<0.01, respectively). Abbreviations: BNP, B-type (brain) natriuretic peptide; DM, diabetes mellitus; VAS, visual analog scale.
Figure 2
Figure 2
Multiple regression analysis for clinical parameters related to pruritus in hemodialysis patients. Notes: (A) The standardized regression coefficients in clinical parameters for daytime VAS in hemodialysis patients. Serum BNP is significantly related to worsening daytime pruritus in hemodialysis patients. (B) The standardized regression coefficients for nighttime VAS. Abbreviations: β2-MG, β2-microglobulin; BNP, B-type (brain) natriuretic peptide; DM, diabetes mellitus; TIBC, total iron binding capacity; VAS, visual analog scale.
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