Prevalence, Risk Factors And Relationship Of Pruritus With Blood Lead Level In Chronic Kidney Disease On Maintenance Hemodialysis

Abstract

Nafesa Mohammed Kamal1, Essam Eldin Mahmoud Lotfy, Hatem Elmaghawry Mohammed Elshiekh, Lamiaa Abd Elwahab Mohammed and Ahmed Maher Elsayed.

Background: one of the most nearly daily compromising symptoms in hemodialysis patients is skin itching. Blood lead level (BLLs) may have a risk factor that increase the intensity of hemodialysis pruritus.
Objective: To evaluate the prevalence of pruritus and its relationship with blood lead level in renal patients maintained on hemodialysis.
Patients and Method: Cross -sectional Study carried on100 patients with End stage renal disease (ESRD) divided into Group I; low BLLs (<15 µg/dl) included 56 patients, Group II; High normal BLLs (15 ≤ BLL< 25 µg/dl) included 32 patients and Group III; High BLLs (≥ 25 µg/dl) included 12 patients. All subjects were evaluated for kidney and liver function, electrolytes, CBC, estimation of GFR by MDRD equation, and Lead level in serum and dialysis water.
Results: we found in this study that prevalence of pruritus was (19%), BLLs have a high statistically significant positive relation to HD duration (P<0.001) & I-PTH(P<0.001) & pruritus (P< 0.001) & visual analogue scale (VAS) (P<0.044) and high significant negative relation to serum albumin (P< 0.015) & hemoglobin(P<0.001). Also, Serum Lead (µg/dL) is an independent predictor for incidence of uremic pruritus [odds ratio (OR) =1.207; 95% by Multiple logistic regression analysis
Conclusions: pruritus prevalence was (19%), blood lead level is highly related to pruritus and independent risk factor with HD duration for early onset and progression of itching in chronic haemodialysis patients. So we recommend serum lead investigation in these patients for early detection and reduction of its dermatological and psychological morbidity.