Hydration, barrier of skin and uremic pruritus in patients undergoing hemodialysis: A pilot investigation

Abstract

Background: Chronic kidney disease-associated pruritus is a common symptom for patients with end-stage renal disease on hemodialysis; however, its pathogenesis remains poorly understood. Chronic kidney disease-associated pruritus has been reported to be associated with skin hydration or barrier. Thus, an interaction or association may be observed between chronic kidney disease-associated pruritus, skin hydration, and skin barrier.

Purpose: This study aimed to investigate the association between chronic kidney disease-associated pruritus, skin hydration, and skin barrier in patients with hemodialysis.

Methods: This cross-sectional study was conducted between November 2018 and February 2019. It included 162 patients undergoing maintenance hemodialysis for at least 6 months. Data were collected using the 5-D Itch Scale. Skin hydration and skin barrier were measured according to stratum corneum hydration and transepidermal water loss.

Results: Pruritus occurred in 42% of patients with hemodialysis. The mean 5-D Itch Scale severity was 10.91±4.5. Pearson correlation analysis revealed that pruritus significantly correlated with moisture level (r=0.191; P=0.01), stratum corneum hydration (r=0.191; P=0.01), barrier strength (r=-0.162; P=0.04), and transepidermal water loss (r=0.162; P=0.04).

Conclusion: Chronic kidney disease-associated pruritus remains a serious problem in patients undergoing hemodialysis, and stratum corneum hydration and transepidermal water loss are among its causes. This study illustrates the importance of skin hydration and barrier and sensitization to chronic kidney disease-associated pruritus. Therefore, the possible risk factors of chronic kidney disease-associated pruritus must be monitored closely in patients at risk.

Keywords: Barrier of skin; Chronic kidney disease-associated pruritus; Hydration.