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Abstract
ABSTRACT
BACKGROUND. Pruritus is frequent in chronic hemodialysed patient and alters his quality of life. His pathophysiology is unclarified and his management a challenge for nephrologist.
OBJECTIVE. To assess the impact of pruritus on quality of life of maintenance hemodialysis patients in our setting.
MATERIAL AND METHODS. This was a cross-sectional study, carried from February to May 2014 in two Yaoundé hemodialysis centers, involving any patient on maintenance hemodialysis for at least three months who self-administer a multi-questionnaire specific on uremic pruritus, including Skindex-10 score, Brief Itch Inventory and itch medical outcome survey of sleep. Chi square and t-student tests or equivalents were used for statistical analysis. The level of significance was set at p<0.05.
RESULTS. We recruited 42 patients, 32 (76,2%) male, with a mean age of 51 ± 13 years and a mean duration in dialysis of 40 ± 32 months. Pruritus was moderate to severe in 25 (59,5%) patients. The intensity of pruritus was associated to all parameters of quality of life studied (p < 0,0001). The alteration of quality of life secondary to pruritus severity was associated with advanced age (>50 years), low education level, shorter duration in dialysis (<1 year) and anuria.
CONCLUSION. This study reveals an important quality of life alteration of chronic hemodialysed patients regarding daylight activities and sleep.
RÉSUMÉ
INTRODUCTION. Le prurit est fréquent chez l’hémodialysé chronique et altère sa qualité de vie. Sa physiopathologie est mal élucidée et sa prise en charge reste un défi.
OBJECTIF. Évaluer le retentissement du prurit sur la qualité de vie des hémodialysés chroniques dans notre milieu.
MATERIEL ET METHODES. Il s’agissait d’une étude transversale, menée de Février à Mai 2014 dans les deux centres d’hémodialyse de Yaoundé, incluant tout hémodialysé chronique depuis au moins 3 mois qui s’auto-administrait un multi-questionnaire spécifique au prurit urémique, comprenant les scores Skindex-10, « Brief Itch Inventory », et «itch medical outcome survey of sleep ». Les tests de Chi carré et t- de Student ou équivalents étaient utilisés pour l’analyse statistique. Le seuil de signification était fixé à p<0,05.
RESULTATS. Nous avons colligé 42 patients dont 32 (76,2%) hommes, d’un âge moyen de 51 ± 13 ans et une durée moyenne en dialyse de 40 ± 32 mois. Le prurit était modéré à sévère chez 25 (59,5%) patients. L’intensité du prurit était associée à tous les paramètres de l’altération de la qualité de vie étudiés (p < 0,0001). L’altération de la qualité de vie secondaire à la sévérité du prurit était associée à l’âge avancé (>50ans), au faible niveau d’instruction, à la courte durée en dialyse (<1 an) et à l’anurie.
CONCLUSION. Cette étude révèle une altération importante de la qualité de vie des hémodialysés chroniques qui porte sur les activités quotidiennes et le sommeil.
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References
- Pisoni RL, Wikstrom B, Elder SJ, Akizawa T, Asano Y, Keen ML, et al. Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transpl. 2006 Dec;21(12):3495–505.
- Narita I, Alchi B, Omori K, Sato F, Ajiro J, Saga D, et al. Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney Int. 2006 May;69(9):1626–32.
- Kimata N, Fuller DS, Saito A, Akizawa T, Fukuhara S, Pisoni RL, et al. Pruritus in hemodialysis patients: Results from the Japanese Dialysis Outcomes and Practice Patterns Study (JDOPPS): Pruritus in international dialysis patients. Hemodial Int. 2014 Jul;18(3):657–67.
- Canaud B. Controle de qualité en hémodialyse : démarche assurance qualité. Nephrologie. 2000;21:403–11.
- Davison SN, Jhangri GS. Impact of Pain and Symptom Burden on the Health-Related Quality of Life of Hemodialysis Patients. J Pain Symptom Manage. 2010 Mar;39(3):477–85.
- Weisbord SD, Fried LF, Arnold RM, Fine MJ, Levenson DJ, Peterson RA, et al. Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients. J Am Soc Nephrol 16: 2487–2494, 2005. J Am Soc Nephrol. 2005;16:2487–94.
- Merkus MP, Jager KJ, Dekker FW, Haan RJ de, Boeschoten EW, Krediet RT. Physical symptoms and quality of life in patients on chronic dialysis : Results of The Netherlands Cooperative Study on Adequacy of Dialysis. Nephrol Dial Transpl. 1999;14:1163–70.
- Nunley JR, Hogan DJ, Vinson RP, Chan EF, Elson DM. Dermatologic Manifestations of Renal Disease [Internet]. 2012 [consulted 2014 May 27]. Available from: http://emedicine.medscape.com/article/1094846
- Zucker I, Yosipovitch G, David M, Gafter U, Boner G. Prevalence and characterization of uremic pruritus in patients undergoing hemodialysis: uremic pruritus is still a major problem for patients with end-stage renal disease. J Am Acad Dermatol. 2003 Nov;49(5):842–6.
- Mistik S, Utas S, Ferahbas A. An epidemiology study of patients with uremic pruritus. J Eur Acad Dermatol Venereol. 2006;20:672–8.
- Mathur VS, Lindberg J, Germain M, Block G, Tumlin J, Smith M, et al. A longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol. 2010 Aug;5(8):1410–9.
- Gokal R, Figueras M, Ollé A, Rovira J, Badia X. Outcomes in peritoneal dialysis and hemodialysis: a comparative assessment of survival and quality of life. Nephrol Dial Transpl. 1999;14(suppl 6):24–30.
- Laupacis A, Muirhead N, Keown P, Wong C. A disease-specific questionnaire for assessing quality of life in patients on hemodialysis. Nephron. 1992;60:302–6.
- Mingardi G. From the development to the clinical application of a questionnaire on the quality of life in dialysis, The experience of the Italian Collaborative DIA-QOL (Dialysis-Quality of Life. Nephrol Dial Transpl. 1998;13(Suppl 1):70–5.
- Suseł J, Batycka-Baran A, Reich A, Szepietowski J. Uraemic Pruritus Markedly Affects the Quality of Life and Depressive Symptoms in Haemodialysis Patients with End-stage Renal Disease. Acta Derm Venereol. 2014;94(3):276–81.
- Lopes GB, Nogueira FCP, de Souza MR, Penalva MA, de Amorim JL, Pisoni RL, et al. Assessment of the psychological burden associated with pruritus in hemodialysis patients using the kidney disease quality of life short form. Qual Life Res. 2012 May;21(4):603–12.
- Cengic B, Resic H, Spasovski G, Avdic E, Alajbegovic A. Quality of sleep in patients undergoing hemodialysis. Int Urol Nephrol. 2012 Apr;44(2):557–67.
- Rayner HC, Zepel L, Fuller DS, Morgenstern H, Karaboyas A, Culleton BF, et al. Recovery Time, Quality of Life, and Mortality in Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2014 juillet;64(1):86–94.
- Nasr M, Hadj Ammar M, Khammouma S, Ben Dhia N, Ghachem A. L’hémodialyse et son impact sur la qualité de vie. Néphrologie Thérapeutique. 2008 février;4(1):21–7.
- Halle MP, Kengne AP, Ashuntantang G. Referral of patients with kidney impairment for specialist care in a developing country of sub-Saharan Africa. Ren Fail. 2009;31(5):341–8.
References
Pisoni RL, Wikstrom B, Elder SJ, Akizawa T, Asano Y, Keen ML, et al. Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transpl. 2006 Dec;21(12):3495–505.
Narita I, Alchi B, Omori K, Sato F, Ajiro J, Saga D, et al. Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney Int. 2006 May;69(9):1626–32.
Kimata N, Fuller DS, Saito A, Akizawa T, Fukuhara S, Pisoni RL, et al. Pruritus in hemodialysis patients: Results from the Japanese Dialysis Outcomes and Practice Patterns Study (JDOPPS): Pruritus in international dialysis patients. Hemodial Int. 2014 Jul;18(3):657–67.
Canaud B. Controle de qualité en hémodialyse : démarche assurance qualité. Nephrologie. 2000;21:403–11.
Davison SN, Jhangri GS. Impact of Pain and Symptom Burden on the Health-Related Quality of Life of Hemodialysis Patients. J Pain Symptom Manage. 2010 Mar;39(3):477–85.
Weisbord SD, Fried LF, Arnold RM, Fine MJ, Levenson DJ, Peterson RA, et al. Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients. J Am Soc Nephrol 16: 2487–2494, 2005. J Am Soc Nephrol. 2005;16:2487–94.
Merkus MP, Jager KJ, Dekker FW, Haan RJ de, Boeschoten EW, Krediet RT. Physical symptoms and quality of life in patients on chronic dialysis : Results of The Netherlands Cooperative Study on Adequacy of Dialysis. Nephrol Dial Transpl. 1999;14:1163–70.
Nunley JR, Hogan DJ, Vinson RP, Chan EF, Elson DM. Dermatologic Manifestations of Renal Disease [Internet]. 2012 [consulted 2014 May 27]. Available from: http://emedicine.medscape.com/article/1094846
Zucker I, Yosipovitch G, David M, Gafter U, Boner G. Prevalence and characterization of uremic pruritus in patients undergoing hemodialysis: uremic pruritus is still a major problem for patients with end-stage renal disease. J Am Acad Dermatol. 2003 Nov;49(5):842–6.
Mistik S, Utas S, Ferahbas A. An epidemiology study of patients with uremic pruritus. J Eur Acad Dermatol Venereol. 2006;20:672–8.
Mathur VS, Lindberg J, Germain M, Block G, Tumlin J, Smith M, et al. A longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol. 2010 Aug;5(8):1410–9.
Gokal R, Figueras M, Ollé A, Rovira J, Badia X. Outcomes in peritoneal dialysis and hemodialysis: a comparative assessment of survival and quality of life. Nephrol Dial Transpl. 1999;14(suppl 6):24–30.
Laupacis A, Muirhead N, Keown P, Wong C. A disease-specific questionnaire for assessing quality of life in patients on hemodialysis. Nephron. 1992;60:302–6.
Mingardi G. From the development to the clinical application of a questionnaire on the quality of life in dialysis, The experience of the Italian Collaborative DIA-QOL (Dialysis-Quality of Life. Nephrol Dial Transpl. 1998;13(Suppl 1):70–5.
Suseł J, Batycka-Baran A, Reich A, Szepietowski J. Uraemic Pruritus Markedly Affects the Quality of Life and Depressive Symptoms in Haemodialysis Patients with End-stage Renal Disease. Acta Derm Venereol. 2014;94(3):276–81.
Lopes GB, Nogueira FCP, de Souza MR, Penalva MA, de Amorim JL, Pisoni RL, et al. Assessment of the psychological burden associated with pruritus in hemodialysis patients using the kidney disease quality of life short form. Qual Life Res. 2012 May;21(4):603–12.
Cengic B, Resic H, Spasovski G, Avdic E, Alajbegovic A. Quality of sleep in patients undergoing hemodialysis. Int Urol Nephrol. 2012 Apr;44(2):557–67.
Rayner HC, Zepel L, Fuller DS, Morgenstern H, Karaboyas A, Culleton BF, et al. Recovery Time, Quality of Life, and Mortality in Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2014 juillet;64(1):86–94.
Nasr M, Hadj Ammar M, Khammouma S, Ben Dhia N, Ghachem A. L’hémodialyse et son impact sur la qualité de vie. Néphrologie Thérapeutique. 2008 février;4(1):21–7.
Halle MP, Kengne AP, Ashuntantang G. Referral of patients with kidney impairment for specialist care in a developing country of sub-Saharan Africa. Ren Fail. 2009;31(5):341–8.