Multiple Factors Analysis And Case-Control Study Of Therapy Of Uremic Pruritus

Objective: To analyse the risk factors of uremic pruritus and seek effective intervention methods of uremic pruritus, which is one of the most common complications of dialytic patients. The prevalence of uremic pruritus ranges between 50%-90%. Despite the clinical importance of this tormenting sensation, little is known about its pathogenic mechanism. Additionally, so far no satisfactory therapeutic modalities are available.Methods: 38 patients with pruritus and 13 non-pruritic patients who were under maintenance hemodialysis or peritoneal dialysis were included. The extent of pruritus was evaluated on a visual analog scale (VAS) and a behavior rating scale (BRS). The emotion was evaluated on VAS, too. Sex, age, dialysis pattern, duration of dialysis, xerosis were compared between pruritic and non-pruritic patients. Hb, PTH, Ca, Mg, P, CaXP, BUN and Scr were determined. The 38 pruritic patients were grouped into Group A, Group B, Group C and Group D by case-control study principle, and given oral activated charcoal (6g/d for 4 weeks), hemodiafiltration (once another week for 4 times), neurotropin (3.6u/d for 2 weeks) and non-specific therapy correspondingly. All patients were under erythropoietin (EPO) therapy.Result: Emotion was influenced greatly by the extent of uremic pruritus (P<0.01). Pruritic patients were older than non-pruritic patients, with more common xerosis and a lower level of serum Alb (t=2.498, 3.403, 3.136, P<0.05). The extent of pruritus also correlated with post-therapeutic serum concentration of P, CaXP and PTH (r=0.629, 0.674, 0.671, P<0.05). Sex, dialysis pattern, duration of dialysis, Hb, BUN and Scr did not correlate with pruritus (P>0.05). Oral activated charcoal, hemodiafiltration and neurotropin showd significantly therapeutic effects on uremic pruritus (t=4.474, 2.830, 4.367,P<0.05). Oral activated charcoal and hemodiafiltration therapy could decrease the serum concentrations of P, PTH significantly(P<0.05). EPO has no significantly therapeutic effects on uremic prurits (P>0.05) . Conclusion: Uremic pruritus may correlate with age, xerosis, serum Alb, P, Ca X P and PTH. Oral activated charcoal, hemodiafiltration and neurotropin are effective interventions. EPO has no significantly therapeutic effects.