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NDT Advance Access originally published online on August 23, 2007
Nephrology Dialysis Transplantation 2007 22(12):3669; doi:10.1093/ndt/gfm570
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org


Uraemic pruritus in RDT patients: is it still a problem?

Email: dialisi{at}asl21.piemonte.it

Sir,

We read with interest the article by Pisoni et al., concerning pruritus in HD patients from an international study (DOPPS) [1]. The authors reported a high prevalence of pruritus in the dialytic population, with a wide variability among different units (10–70%) and countries (36–50%). Although many factors were related to uraemic pruritus, there was no definite conclusion drawn as to the pathogenesis of this symptom, and the large difference in its prevalence among the different countries was not explained by a comprehensive adjustment of many parameters.

In our unit, among the 78 patients (age 66 ± 14 years, vintage 70 ± 67 months) on extracorporeal RDT, all undergoing online HDF, 28 patients (36%) had complained of generalized pruritus either continuously or close to the session in some periods while on dialysis. Pruritus disappeared in every patient by stopping antibiotics or aspitin or ticlopidine (n = 13), by avoiding fixed dressings for fistula needles (n = 14), or by avoiding woollen cloth (n = 1). No patient complained of pruritus at the time of this investigation in our unit.

In agreement with other authors [2], the present observation suggests that high efficiency and biocompatibility, such as that obtained by online HDF, could decrease dialytic inflammation, and thus the occurrence of pruritus. Moreover, other factors and especially the use of fixed dressings, can cause generalized pruritus beyond the shunt arm.

Therefore, in well-dialysed patients, factors other than uraemia or dialysis can play a role in the pathogenesis and persistence of pruritus in RDT patients.

Marco Gonella, Giovanni Calabrese, Antonio Mazzotta and Giuseppe Vagelli

Renal Unit
Ospedale S. Spirito
Casale Monferrato, Italy

Notes

Note: Dr Pisoni was invited to provide a reply, but we did not receive a response.

References

  1. Pisoni RL, Wikstrom B, Elder SJ, et al. Pruritus in haemodialysis patients: international results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant (2006) 21:3495–3505.[Abstract/Free Full Text]
  2. Mettang T, Pauli-Magnus C, Alscher DM. Uraemic pruritus – new perspectives and insights from recent trials. Nephrol Dial Trasplant (2002) 17:1558–1563.[CrossRef]

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This Article
Right arrow Extract Freely available
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Right arrow All Versions of this Article:
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gfm570v1
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Right arrow Articles by Gonella, M.
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