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Uremic pruritus

Jennifer S Scherer, Sara A Combs, Frank Brennan
Maintenance dialysis patients experience a high burden of physical and emotional symptoms that directly affect their quality of life and health care utilization. In this review, we specifically highlight common troublesome symptoms affecting dialysis patients: insomnia, restless legs syndrome, and uremic pruritus. Epidemiology, pathophysiology, and evidence-based current treatment are reviewed with the goal of providing a guide for diagnosis and treatment. Finally, we identify multiple additional areas of further study needed to improve symptom management in dialysis patients...
September 29, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Berna Solak, Yalcin Solak
No abstract text is available yet for this article.
August 10, 2016: Journal of Dermatological Treatment
Mio Nakamura, John Koo, Tina Bhutani
Uremic pruritus (UP) is a common condition among patients with chronic kidney disease (CKD) on hemodialysis (HD). We report 19 a case of severe UP recalcitrant to conventional therapy including topical corticosteroids, anti-histamines, and phototherapy, 20 which was treated successfully with the Goeckerman regimen consisting of topical coal tar, topical corticosteroids, and broadband 21 UVB (BB-UVB). Little is known about the pathophysiology of UP, and there is currently no consensus or evidence-based 22 treatments for UP...
2016: Dermatology Online Journal
Thomas Mettang
Uremic itch is a frequent and sometimes very tormenting symptom in patients with advanced or end-stage renal failure, with a strong negative impact on the quality of life. According to a representative study, the point prevalence of chronic itch is 25% in hemodialysis patients but may reach more than 50% in single cohorts depending on the country and dialysis efficacy. Not much is known regarding the pathogenesis of uremic itch. Besides parathyroid hormone, histamine, tryptase, and alteration of the calcium-phosphate metabolism have been suspected...
2016: Current Problems in Dermatology
Manuel Pedro Pereira, Sonja Ständer
Pruritus is a symptom arising from a plethora of dermatological, neurological, and systemic conditions. The pathophysiological mechanisms involved in the transmission of acute and chronic pruritus are of high complexity and not yet fully understood. Recent research has enhanced the understanding of these mechanisms, enabling the development of novel drugs. Specifically, new therapies for inflammatory dermatoses, uremic pruritus, cholestatic pruritus, cutaneous T-cell lymphoma, and prurigo nodularis are being tested in ongoing randomized clinical trials...
2016: Current Problems in Dermatology
Alice Thébaut, Dalila Habes, Frédéric Gottrand, Christine Rivet, Joseph Cohen, Dominique Debray, Emmanuel Jacquemin, Emmanuel Gonzales
BACKGROUNDS/AIM: Pruritus is a severe symptom accompanying chronic cholestasis. It can be debilitating and difficult to control. In children, first-line treatments are ursodeoxycholic acid and rifampicin. Refractory pruritus may require invasive therapies including liver transplantation. Clinical trials based on small samples of adult patients suggest that serotonin reuptake inhibitors can improve pruritus in cholestatic or uremic disease. We performed a prospective, multicenter study to assess efficiency and safety of the serotonin reuptake inhibitor sertraline in treating children with refractory cholestatic pruritus...
August 24, 2016: Journal of Pediatric Gastroenterology and Nutrition
Wen-Hung Huang, Jui-Hsiang Lin, Cheng-Hao Weng, Ching-Wei Hsu, Tzung-Hai Yen
Uremic pruritus (UP), also known as chronic kidney disease-associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution-induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD...
2016: Scientific Reports
Tiankai Du, A Bar-Hen, Jasvinder S Bhatia, Deon Wolpowitz
No abstract text is available yet for this article.
July 20, 2016: Journal of Investigative Dermatology
Nazanin Foroutan, Abbas Etminan, Naemeh Nikvarz, Mohadese Shojai Shahrokh Abadi
Introduction Pruritus is one of the frustrating skin manifestations of advanced renal failure. Many options have been used for the management of uremic pruritus (UP) such as pregabalin. There are some studies that reported beneficial effects of pregabalin in reducing UP; however, most of them did not have a comparator arm. Therefore, we designed this study to compare antipruritic effects of pregabalin with doxepin in the management of pruritus in hemodialysis patients. Methods Seventy-two patients suffering from UP were randomly assigned to receive pregabalin (50 mg every other day) or doxepin (10 mg per day) for 4 weeks...
July 11, 2016: Hemodialysis International
A E Kremer, T Mettang
Chronic pruritus is a symptom of various internal disorders. In contrast to dermatological diseases, pruritus does not present with primary skin alterations in these patients. However, intense scratching may cause secondary skin changes such as abrasion, excoriation, prurigo nodularis, or in rare cases even scaring. The most common internal medicine causes for chronic pruritus are chronic kidney disease, hepatobiliary and hematological disorders as well as adverse drug reactions. Pruritus is less commonly seen in patients with endocrine or metabolic diseases, malabsorption syndromes, infectious diseases and solid tumors...
August 2016: Der Hautarzt; Zeitschrift Für Dermatologie, Venerologie, und Verwandte Gebiete
Ji-Won Min, Su-Hyun Kim, Young Ok Kim, Dong Chan Jin, Ho Chul Song, Euy Jin Choi, Yong-Lim Kim, Yon-Su Kim, Shin-Wook Kang, Nam-Ho Kim, Chul Woo Yang, Yong Kyun Kim
BACKGROUND: Uremic pruritus is a common, but unpleasant, complication of end-stage renal disease. The uremic burden may differ between hemodialysis (HD) and peritoneal dialysis (PD) patients. This difference may also change the clinical characteristics of uremic pruritus between the 2 modalities. In this study, we investigated the uremic pruritus between patients on HD and PD. METHODS: A total of 425 HD and 223 PD patients from the Clinical Research Center registry in Korea were included...
June 2016: Kidney Research and Clinical Practice
Elena P Calandre, Fernando Rico-Villademoros, Mahmoud Slim
INTRODUCTION: The first two alpha2delta ligands - gabapentin (GBP) and pregabalin (PGB) - were initially synthesized as antiepileptics; however, they were later also found to be useful for the treatment of additional conditions. AREAS COVERED: Relevant publications describing potential underlying mechanisms, clinical pharmacokinetics/pharmacokinetics, and clinical efficacy and safety of these drugs in various disease conditions were searched in PubMed and Scopus and included in this review...
July 7, 2016: Expert Review of Neurotherapeutics
C-C Wang, C-H Tang, C-Y Wang, S-Y Huang, Y-M Sue
BACKGROUND: Chronic haemodialysis (HD) patients have a higher incidence of cancer. However, the risk of skin cancer in this population has rarely been investigated. OBJECTIVES: To investigate the risk of non-melanoma skin cancer (NMSC) and cutaneous melanoma in chronic HD patients and explore the associated risk factors. METHODS: We performed retrospective cohort and nested case-control studies using records in the Taiwanese National Health Insurance Research Database between 1999 and 2013...
June 7, 2016: British Journal of Dermatology
Nazan Kılıç Akça, Sultan Taşcı
Context • Uremic pruritus, a frequent and compromising symptom for patients with advanced or end-stage renal disease (ESRD), strongly reduces the patient's quality of life. Pruritus may be extremely difficult to control because therapeutic options are limited. Topical products are frequently used for easing pruritus, but their effects are generally temporary and marginal. Although acupressure and electrical-stimulation methods for the application of acupressure have been evaluated separately in terms of pruritus efficiency in different studies, the existence of any difference between the efficacies of the 2 methods has not been assessed yet...
March 2016: Alternative Therapies in Health and Medicine
Kazuki M Matsuda, Divya Sharma, Ariel R Schonfeld, Shawn G Kwatra
Chronic pruritus is a distressing symptom that is often refractory to treatment. Patients frequently fail topical therapies and oral over-the-counter antihistamines, prompting the clinician to consider alternative therapies such as neuroactive agents. Herein, the use of gabapentin and pregabalin, 2 medications well known for treating neuropathic pain and epilepsy that are occasionally used for relieving chronic pruritus is explored. The findings from original sources published to date to evaluate the use of gabapentin and pregabalin as antipruritic agents are explored...
September 2016: Journal of the American Academy of Dermatology
Chao-Ping Wang, Yung-Chuan Lu, I-Ting Tsai, Wei-Hua Tang, Chia-Chang Hsu, Wei-Chin Hung, Teng-Hung Yu, Shih-Chieh Chen, Fu-Mei Chung, Yau-Jiunn Lee, Jer-Yiing Houng
BACKGROUND: Pruritus is a common and distressing symptom that affects patients with chronic kidney disease (CKD). Indoxyl sulfate (IS) and p-cresylsulfate (PCS) are uremic toxins with similar protein binding, dialytic clearance, and proinflammatory features. Pruritus in CKD may correlate better with uremic toxins than the glomerular filtration rate (GFR), suggesting that uremic toxins either in the central nervous system or peripherally may play an important role in the pathophysiology...
2016: Dermatology: International Journal for Clinical and Investigative Dermatology
Eman Nofal, Fawzia Farag, Ahmad Nofal, Fatma Eldesouky, Reham Alkot, Zeinab Abdelkhalik
BACKGROUND: Treatment of uremic pruritus (UP) is a big challenge. OBJECTIVES: To evaluate efficacy, appropriate dosing regimen and safety of gabapentin on UP in hemodialysis (HD) patients. PATIENTS AND METHODS: Fifty-four uremic patients undergoing HD and complaining of UP were randomly classified into two equal groups. Gabapentin group: 27 patients received gabapentin capsules starting with 100 mg and gradually titrated up to a maximum of 300 mg after each HD session for one month...
April 4, 2016: Journal of Dermatological Treatment
Monika Heisig, Łukasz Łaczmański, Adam Reich, Felicja Lwow, Jacek C Szepietowski
Uremic pruritus (UP) is a frequent and bothersome symptom in hemodialysis patients. Its etiology is not fully understood and that is why there is no specific treatment. The endocannabinoid system plays a role in many pathological conditions. There is reliable evidence on the association between cannabinoid system and pruritus. In our study, we aimed to evaluate whether genetic variations in the endocannabinoid receptor 1 (CNR1) gene can affect UP. The rs12720071, rs806368, rs1049353, rs806381, rs10485170, rs6454674, and rs2023239 polymorphisms of the CNR1 gene were genotyped in 159 hemodialysis patients and 150 healthy controls using two multiplex polymerase chain reactions and the minisequencing technique...
2016: BioMed Research International
Torey Lau, Sharon Leung, Wynnie Lau
PURPOSE OF THE REVIEW: Uremic pruritus (UP) is a common discomfort of dialysis-dependent end-stage renal disease. Some studies suggest a neuropathic cause of UP. Gabapentin, an anticonvulsant, has shown promising results as an emerging drug to treat this condition. OBJECTIVE: An updated qualitative systematic review was conducted to evaluate its efficacy and safety in hemodialysis patients. SOURCE OF INFORMATION: Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Clinicaltrials...
2016: Canadian Journal of Kidney Health and Disease
Saeid Amirkhanlou, Anna Rashedi, Jalal Taherian, Ali Akbar Hafezi, Sahar Parsaei
OBJECTIVES: Uremic pruritus is a common problem in hemodialysis patients. Several treatments have been used for decreasing itching in these patients. Gabapentin and ketotifen are two drugs used for treating uremic patients. The aim of this study was to compare gabapentin and ketotifen in treatment of uremic pruritus in hemodialysis patients. METHODS: In this double-blind randomized clinical trial, 52 hemodialysis patients with uremic pruritus referred to 5azarTeaching Hospital in Gorgan in 2013 were studied...
January 2016: Pakistan Journal of Medical Sciences Quarterly
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