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NDT Advance Access originally published online on April 2, 2009
Nephrology Dialysis Transplantation 2009 24(9):2803-2809; doi:10.1093/ndt/gfp143
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


The impact of dialysis modality on skin hyperpigmentation in haemodialysis patients

Sung Jin Moon*, Dong Ki Kim*, Jae Hyun Chang, Chan Ho Kim, Hyun Wook Kim, Sun Young Park, Seung Hyeok Han, Jung Eun Lee, Tae-Hyun Yoo, Dae Suk Han and Shin-Wook Kang

Department of Internal Medicine, College of Medicine, Brain Korea 21 for Medical Science, Yonsei University, Seoul, Korea

Correspondence and offprint requests to: Shin-Wook Kang; E-mail: kswkidney{at}yumc.yonsei.ac.kr



  Abstract

Background. Skin hyperpigmentation in end-stage renal disease (ESRD) patients has been attributed to the accumulation of middle-molecular-weight (MMW) substances. Although an MMW mechanism suggests that hyperpigmentation may be improved by high-flux haemodialysis (HF-HD) and haemodiafiltration (HDF), this possibility has not been explored. In the present study, we investigated the impact of different dialysis modalities on skin colour in HD patients.

Methods. Eighty-two ESRD patients on HD were divided into low-flux HD (LF-HD), HF-HD and HDF groups. The melanin index (MI) and erythema index (EI) of the abdomen and the flexor side of the forearm (non-sun-exposed areas) and the forehead (sun-exposed area) were determined by using a narrow-band reflectance spectrophotometer at baseline and after 12 months.

Results. Even though absolute values of baseline and follow-up MI and EI of the three sites were comparable among the three groups, forehead MI and EI were significantly decreased after 12 months in the HDF group (P < 0.05). In addition, the change in forehead MI was significantly greater in the HDF than in the LF-HD group (–1.0 ± 2.4% versus 0.3 ± 1.6%, P < 0.05). Moreover, β2-microglobulin reduction rates were negatively correlated with both changes in forehead MI (P < 0.01) and EI (P < 0.05).

Conclusions. Skin colour of sun-exposed areas was signi- ficantly decreased in ESRD patients receiving HDF therapy, suggesting that enhanced removal of MMW substances by convection may prevent or reduce hyperpigmentation in HD patients.

Keywords: β2-microglobulin; haemodiafiltration; hyperpigmentation; low-flux haemodialysis; spectrophotometer

* Both the authors contributed equally to this work.

Received for publication: 14.10.08
Accepted in revised form: 2. 1.09


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