Is there any relationship between dialysis and itching?

Question

65 years old man on CAPD dialysis since the last 10 months. I want to know if Bactroban ointment(mupirocin) can be applied daily to the exit site? The skin around the exit site is itchy and sometimes it pains too. Can I apply paraffin oil to reduce the severe itching problem on my back? Can you suggest me some skin lotions as well - is loratidine tablet safe? I never took erythropoietin hormone injection since I am on dialysis but my haemoglobin level is always around 9 - 10 gm/dl. If I have 90% kidney failure, then how come I have this much haemoglobin? Most of the time I undergo only two exchanges a day.

Answer 1

Q. What causes the skin to itch after dialyzing?

A. Itching is a common complaint of patients with kidney disease. Among those requiring dialysis, 40-90 percent experience this symptom. The cause is unknown, but it is likely due to a combination of factors as indicated by the variability in symptoms and response to therapy. Possible contributing agents include dry skin, high blood levels of vitamin A, calcium, phosphorus, parathyroid hormone, beta2-microglobin and increased histamine levels in the skin. Additionally, other disorders such as the underlying cause of the patient's renal failure, allergies, gallbladder disease and cancers may be the source of itching in persons with kidney disease.



The onset, course and response to treatment are variable. While a majority of patients first experience this symptom after the initiation of dialysis, some patients may begin to itch before reaching end-stage renal disease (ESRD). Itching occurs equally often among patients dialyzing by hemodialysis or peritoneal dialysis (PD). The itching may be localized to one area of the body or generalized. The itching may be constant or intermittent. Itching

Itching is a common complaint among dialysis patients, although not all patients are troubled by it. While no one knows the exact cause(s), itching may be brought about by:
# Dry skin
# High Phosphorus Levels
# Allergic Reactions
# High Blood Levels of Parathyroid Hormone (PTH)

Among dialysis patients, itching is most often caused by dry skin. It occurs because the skin is not making enough oil to moisturize itself. It is important to keep the skin clean and moisturized. It may help to use a moisturizing soap when you bathe, to apply unscented body oil, and to use body lotions.

Another factor related to itching may be your diet. In your blood, phosphorus combines with calcium to form phosphorus-calcium products. Some of these phosphorus-calcium products are excreted through your skin and this may cause you to itch. The best way to avoid this is to keep your phosphorus level normal. Maintain your dialysis diet and take phosphorus binders with each meal or large snack as directed.

Allergic reactions to the dialyzer, blood tubing or medications may occur during the hemodialysis treatment. Keep a record of how you feel during your treatment. Maintaining such a log may help you to pinpoint the causes of your itching. Discuss how you feel with your doctor or nurse. There are medications available that may help you.

A blood test can tell if you have a high level of parathyroid hormone (PTH). PTH levels are often elevated in dialysis patients due mainly to a decreased calcium level and an increased phosphorus level. This condition stimulates the parathyroid gland to secrete excessive hormones. This can lead to bone disease. Symptoms may or may not occur. If symptoms appear, the bone disease may already be severe. The most common symptoms are bone pain, joint discomfort and itching. Treatment includes controlling calcium and phosphorus levels with phosphate binders and taking Vitamin D.

http://www.aakp.org/AAKP/RenalifeArt/2003/itchyskin.htm
http://kidney.niddk.nih.gov/kudiseases/pubs/hemodialysis/
http://www.davita.com/articles/dialysis/index.shtml?id=
http://www.biomedcentral.com/1471-5945/5/7
http://www.rdoctor.com
http://www.kidneypatientnews.org/kpt7.htm
http://www.americanheart.org/presenter.jhtml?identifier=47
http://www.symptomat.com
http://www.mayoclinic.com/health/metabolic%20syndrome/DS005
http://www.nlm.nih.gov/medlineplus/metabolicsyndromex.htm
http://www.medicinenet.com/metabolic_syndrome/article.ht

Answer 2

1

Answer 3

ITCHING: The itching you describe is most likely a result of the adhesive from the bandage used to stop the bleeding when the needles are pulled at the end of treatment. Ask your technician or nurse if there is another kind of tape that they can use.

General itching is most often caused by high phosphorus levels, so be sure to take your phosphorus binders, like TUMS or Renagel.

If the itching is too severe, and over-the-counter lotions don't work, consult your physician. There may be a prescription lotion or cream, or IV Benadryl to reduce the itching.

HEMOGLOBIN: You stopped taking EPO when you began dialysis because EPO is given during your dialysis treatment. Your hemoglobin and hematocrit levels are closely monitored by your dialysis facility and your EPO doses are adjusted accordingly.