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NDT Advance Access originally published online on May 29, 2008
Nephrology Dialysis Transplantation 2008 23(11):3685-3689; doi:10.1093/ndt/gfn303
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Association of uraemic pruritus with inflammation and hepatitis infection in haemodialysis patients

Yen-Ling Chiu1,2, Hung-Yuan Chen1,2, Yi-Fang Chuang3, Shih-Ping Hsu1,2, Chun-Fu Lai1,2, Mei-Fen Pai1,2, Shao-Yo Yang1,2 and Yu-Sen Peng1,2

1 Department of Internal Medicine, Far-Eastern Memorial Hospital, Taipei 2 Department of Medicine, National Taiwan University Hospital 3 Department of Psychiatry, Min-Sheng Hospital, Tao-Yuan, Taiwan

Correspondence and offprint requests to: Yu-Seng Peng, Nephrology Division, Far-Eastern Memorial Hospital, No 21, Nan-Ya S. Road, Sec 2, Banciao, Taipei County, Taiwan. E-mail: yenling.chiu{at}gmail.com



  Abstract

Background. Chronic inflammation and hepatitis C virus (HCV) infection have been implicated in the pathogenesis of uraemic pruritus in haemodialysis (HD) patients. However, each one's independent roles have not been previously studied.

Methods. A total of 321 HD patients diagnosed with end-stage renal disease with maintenance HD for >3 months were included. A visual analogue scale (VAS) was used to subjectively measure the severity of itching. Based on the VAS score, patients were divided into three groups: Group 1, no pruritus (VAS = 0); Group 2, mild to moderate pruritus (VAS 0–5) and Group 3, severe pruritus (VAS >5).

Results. There were 120 (37.4%) patients without any pruritus, 141 (43.9%) with mild to moderate pruritus and 60 (18.7%) with severe pruritus. Forty-six (14.3%) had hepatitis B virus (HBV) infection and 37 (11.5%) had hepatitis C virus (HCV) infection. The average serum high-sensitivity C-reactive protein (hsCRP) level was 0.58 mg/dl. Patients with severe pruritus had a significantly higher serum hsCRP level and more HBV or HCV infection (all P < 0.05). In the multi-variable logistic regression model, higher levels of hsCRP (OR = 3.54, P = 0.008) and HCV infection (OR = 2.77, P = 0.014) were both significant independent predictors for severe pruritus.

Conclusion. Our study demonstrated the heavy burden of pruritus in HD patients and corroborated the role of inflammation in the pathogenesis of uraemic pruritus. HCV infection is associated with severe uraemic pruritus but is independent of the serum hsCRP level in HD patients.

Keywords: hepatitis C; inflammation; uraemic pruritus

Received for publication: 2. 2.08
Accepted in revised form: 6. 5.08


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