Pruritus and skin hydration during dialysis.

BACKGROUND: Dry skin is frequently observed in uraemic patients and a link with the common complaint of pruritus has been suggested. Objective data on skin dryness in haemodialysed patients is sparse and equivocal. No such information exists for the many patients now receiving peritoneal dialysis. We assessed the prevalence and severity of both pruritus and skin dryness in a uraemic population receiving maintenance dialysis.
METHODS: Forty-eight haemodialysis and 24 peritoneal dialysis patients were examined and skin dryness assessed by clinical grading and measurement of stratum corneum hydration using a corneometer. Forty age- and sex-matched controls were also assessed. Several biochemical parameters with possible relevance to pruritus were measured. Regular emollient therapy was prescribed to pruritic dialysis patients and efficacy assessed.
RESULTS: Dialysis patients overall had clinically drier skin than controls, especially the peritoneal dialysis group. Stratum corneum hydration levels were significantly reduced in the peritoneal dialysis (P < 0.004), but not the haemodialysis, population. Twenty-seven per cent of haemodialysed and 54% of peritoneal dialysis patients complained of pruritus. Pruritic patients in each dialysis group had significantly lower hydration than non-pruritic patients (P < 0.05). Regular emollient use in pruritic patients produced a marked reduction in severity of pruritus, abolishing the symptom in nine of 21 patients treated.
CONCLUSION: Reduced stratum corneum hydration correlates with pruritus in patients on maintenance haemodialysis and peritoneal dialysis, and may be alleviated by simple emollient therapy.