Authors

Yu Wen*, Cheng Liu*, Zehong Lin* Zhenhua Zhang*, Wei Sun*, Xiu Qin*, Yan Wang*, Yunlin Feng**, #

Departments

*Department of Nephrology, People’s Hospital of Ziyang City, Ziyang, China - **Department of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China

Abstract

Aim: Uremic pruritus is common in hemodialysis population. However, there are few studies that have examined the pathophysiology of uremic pruritus in China. 

Methods: We collected demographic and biochemical data from chronic hemodialysis patients and healthy subjects. Fasting blood samples were collected for the measurement of inflammatory mediators including interleukin-2 (IL-2) and interleukin-6 (IL-6) and anaphylactic mediators including mast cell tryptase (MCT) and histamine (HIS). The presence and severity of pruritus and impact of pruritus on life quality were evaluated and classified using visual analogue scale (VAS), 5-D and DIQI scales. Differences between groups and among subgroups were compared. Logistic regression analysis was performed to identify potential risk factors for uremic pruritus. 

Results: There were 131 hemodialysis patients and 107 healthy subjects enrolled. More than 80% of patients had uremic pruritus, with 35.9–57.3% of patients having moderate-to-severe pruritis. The levels of anaphylactic mediators and inflammatory mediators were significantly higher in HD patients than those in healthy controls. MCT, histamine and IL-6 varied greatly among subgroups with different severities of pruritus. Male patients with longer HD vintage and smoking tended to have severe pruritus on VAS scale; however, this effect seemed nonexistent on 5-D and DIQI scales. Logistic regression showed no significant risk factor on all three scales. 

Conclusion: Over 80% of HD patients were bothered by uremic pruritus, among whom, 36-57% of patients had moderate-to-severe pruritus. Anaphylaxis and inflammation contribute to the development of uremic pruritus, and treatment aiming at these mechanisms might be helpful in clinical practice. 

Keywords

Anaphylaxis, hemodialysis, inflammation, mechanisms, uremic pruritus.

DOI:

10.19193/0393-6384_2020_3_245