Nephrol Dial Transplant (1996) 11: 2439-2443
© 1996 European Renal Association-European Dialysis and Transplant Association
research-article
Uraemic pruritus and exposure to di(2-ethylhexyl)phthalate (DEHP) in haemodialysis patients
1Robert-Bosche-Krankenhaus, Department of Internal Medicine, Division of Nephrology Auerbachstr. 110, 70376 Stuttgart, Germany 2Department of Occupational and Social Medicine, University of Tübingen Germany
Correspondence and offprint requests to: Correspondence to: Dr T. Mettang, Robert-Bosch-Krankenhaus, Auerbachstrasse 110, 70376 Stuttgart, Germany
Correspondence and offprint requests to: Offprint requests to: Prof. Dr U. Kuhlmann, Robert-Bosch-Krankenhaus, Department of Internal Medicine, Division of Nephrology, Auerbachstr. 110, 70376 Stuttgart, Germany
Uraemic pruritus is a frequent and disabling symptom in patients on dialysis. The pathogenesis of uraemic pruritus is nevertheless still obscure. We investigated whether di (2-ethylhexyl ) phthalate (DEHP), the most commonly used plasticizer in polyvinyichloride (PVC) haemodialysis tubings, is a possible pathogenetic factor in uraemic pruritus. Serum concentrations of DEHP and its major derivatives mono-(2-ethylhexyl ) phthalate (MEHP), 2-ethylhexanol (2-EH) and phthalic acid (PA) were determined in uraemic patients before and after a haemodialysis session and compared with the occurrence and intensity of pruritus in these patients. Twenty-one patients on regular haemodialysis for at least 6 months were examined. The severity of uraemic pruritus was assessed using a standard questionnaire (pruritus score). The quantitative analysis of DEHP and its derivatives was carried out by GC/selected ion monitoring mass spectrometry. Fourteen out of 21 patients (66%) complained about uraemic pruritus to a variable degree. The post-dialysis serum concentrations of DEHP, MEHP and 2-EH were significantly higher than the corresponding pre-dialysis values, whereas the post-dialysis concentrations of PA (0.122±0.078 µg/ml) were significantly lower than pre-dialysis levels (0.194±0.101 µg/ml, P=0.00068). Neither pre- nor post-dialysis serum concentrations of DEHP, MEHP, PA or 2-EH were correlated with the severity of uraemic pruritus. Additionally, serum concentrations of DEHP and its metabolites did not differ significantly in patients with and without pruritus. These findings suggest that patients on haemodialysis are regularly exposed to considerable amounts of DEHP and metabolites. Phthalic acid, one of the presumed end products of DEHP metabolism, might be eliminated at least in part by haemodialysis. The exposition to DEHP and metabolites during haemodialysis, as assessed by measuring serum concentrations, bears no immediate realtion to the occurence or intensity of uraemic pruritus.
Keywords: uraemia; pruritus; haemodialysis; plasticizer; DEHP; phthalates
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