Kidney dialysis patients not only need to eat carefully, but also need to go to the hospital 2-3 times a week for dialysis.
In addition, the dialysis time is long, and physical and mental fatigue occurs after dialysis. In particular, itching (dialysis itch) occurs frequently and causes a decrease in quality of life, but the cause is not yet clear.
Meanwhile, a research team at Niigata University of Dentistry in Japan analyzed outpatient dialysis patients to examine factors linked to dialysis pruritus and announced in the Clinical Kidney Journal that protein-binding uremic toxin ( PBUT) is involved and may predict pruritus.
According to the research team, approximately 70% of dialysis patients suffer from itching. The main risk factors are male sex, high levels of urea nitrogen in the urine, hypercalcemia and hyperphosphatemia. Protective factors are known to be low calcium levels and high parathyroid hormone levels.
Recently, with the advancement of dialysis technology, it has become possible to effectively remove toxins with poor protein binding properties and low molecular weight, such as blood urea nitrogen, creatinine, and uric acid. Furthermore, antiphosphorus treatments with new mechanisms have appeared. However, the prevalence of dialysis pruritus is still high and it is a serious complication.
The research team focused on PBUT, which is difficult to remove during hemodialysis due to its high protein binding properties and high molecular weight. The subjects of this study were 135 outpatient dialysis patients (101 men, mean age 65 years). Their dialysis period is 89 months.
We examined the relationship between PBUT and other clinical trial values and backgrounds, including the prevalence, severity, and site of dialysis pruritus. The severity of itching was assessed by a score (5D-itch scale, from 5 to 25 points, the greater the severity), which consists of 5 factors (duration, degree, progress, site of onset and related disorders) and the frequency of itching. use of dialysis pruritus treatment. Accuracy was assessed using VAS (visual analogue scale, 0 to 10 points, the greater the severity).
A score of 6 or higher on the 5D-itch/treatment use scale was defined as the “itch group,” while a score of 5 or lower/no treatment use was defined as the “no-itch group.” The concentration of PBUT in blood was measured by mass spectrometry using serum samples.
As a result of the review, dialysis pruritus appeared in 51 patients (38%). Sites of onset were distributed throughout the body, including the back (55%), legs (23%), thighs (19%), and upper arms (18%) from shoulder to elbow. Oral medications used for treatment were antihistamines (26%), nalfurafin (19%), and steroids (4%), and topical medications were antihistamines (15%), heparin-like substances (9.5%), and steroids (8 %). .
The hemodiafiltration rate was higher in the pruritus group than in the non-pruritus group (19% vs. 41%), but there were no other differences between the two groups in terms of age, male/female ratio, dialysis period, obesity index (BMI) and clinical test values. Furthermore, no significant difference in PBUT concentration in the blood before dialysis was found between the two groups.
Considering the nature of PBUT, which causes itching through multiple pathways, the research team calculated the PBUT score using a probability estimation method (maximum likelihood method). Consequentially, It was significantly higher in patients who did not maintain residual renal function compared to patients who did (-0.558 vs 0.076). It was also significantly higher in the no-itch group (-0.120 vs. 0.201).
Even after adjusting for age, sex, dialysis experience, dialysis method, and kidney disease quality of life (KD-QOL), PBUT score and dialysis pruritus were significantly correlated.It turned out that this is the case.
Based on these findings, the research team stated: “The PBUT score has been shown to be useful in predicting dialysis pruritus. If a PBUT removal method is developed, it can be applied not only to the treatment of pruritus but also other dialysis-related conditions”. stones.”
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