Muco-cutaneous manifestations of chronic kidney disease with or without hemodialysis
Keywords:Chronic kidney disease, Haemodialysis, End stage renal disease, Cutaneous manifestations
Background: Mucocutaneous manifestations significantly impair the quality of life of patients with chronic kidney disease (CKD) but are usually understudied. Our objective was to study the patterns and prevalence of mucocutaneous and nail involvement in CKD patients and to compare those in patients with or without haemodialysis.
Methods: Ninety patients aged 18-80 years having CKD (M: F=1.64:1) since mean duration of 4.43±9.9 months were studied in an observational cross-sectional study. Sixty-two (68.9%) patients were on hemodialysis since 42.64±63.14 months. Detailed history and examination, and relevant investigations like KOH mount, skin biopsy, gram stain and culture were done when required. Data was analyzed using SPSS version 21 software. Relevant tests were applied, p<0.05 was considered statistically significant.
Results: Xerosis in 43 (47.7%), pruritus in 26 (28.9%), ichthyosis in 11 (12.2%), and skin pallor in 7 (7.8%) patients were major dermatoses. Xerosis was more commonly found in patients on haemodialysis (37.8%) as compared to those without dialysis (9.9%) (p-0.046). Bullous lesions, perforating folliculitis and foot ulcers occurred in 1 (1.1%) patient each. Common nail abnormalities were longitudinal ridging (21.1%), leukonychia (13.3%), Lindsay’s half‐and‐half nails (4.4%) and dystrophic nails (4.4%). Mucosal manifestations were coated tongue (2.2%%), angular cheilitis (2.2%), and pigmented tongue (1.1%).
Conclusions: Xerosis, pruritus, ichthyosis skin pallor, longitudinal ridging, leukonychia, coated tongue, and angular cheilitis were the common mucocutaneous manifestations in our study. Early recognition and management of these dermatoses plays a crucial role in a holistic patient treatment, reduce disease morbidity and improve their quality of lives.
Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: A position statement from kidney disease: Improving global outcomes (KDIGO). Kidney Int. 2005;67:2089‐100.
Singh AK, Farag YM, Mittal BV, Subramanian KK, Reddy SRK, Acharya VN, et al. Epidemiology and risk factors of chronic kidney disease in India - Results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol. 2013;14:114.
Khanna D, Singhal A, Kalra OP. Comparison of cutaneous manifestations in chronic kidney disease with or without dialysis. Postgrad Med J. 2010;86:641-7.
Tajbakhsh R, Dehghan M, Azarhoosh R, Haghighi AN, Sadani S, Zadeh SS, et al. Mucocutaneous manifestations and nail changes in patients with end-stage renal disease on hemodialysis. Saudi J Kidney Dis Transpl. 2013;24:36-40.
Hajheydari Z, Makhlough A. Cutaneous and mucosal manifestations in patients on maintenance hemodialysis: a study of 101 patients in Sari, Iran. Iran J Kidney Dis. 2008;2:86‐90.
Mirza R, Wahid Z, Talat H. Dermatologic manifestations in chronic renal failure patients on hemodialysis. J Liaquat Uni Med Health Sci. 2012;11:24‐8.
Shah A, Hada R, Kayastha BM. Dermatological disorders in chronic kidney disease with and without maintenance hemodialysis. JNMA J Nepal Med Assoc. 2013;52:365‐71.
Salhab AM, Shalhub S, Morgan MB. A current review of the cutaneous manifestations of renal disease. J Cutan Pathol. 2003;30:527‐38.
Lupi O, Rezende L, Zangrando M, Sessim M, Silveira CB, Sepulcri MA, et al. Cutaneous manifestations in end stage renal disease. An Bras Dermatol. 2011;86:319‐26.
Petkov T, Dencheva R, Tsankov N. Skin changes of patients on dialysis treatment. J Turk Acad Dermatol. 2010;4:4301.
Szepietowski JC, Reich A, Schwartz RA. Uremic xerosis. Nephrol Dial Transplant. 2004;19:2709‐12.
Pico MR, Somolinos LA, Sanchez JL, Burgos Calderon R. Cutaneous alterations in patients with chronic renal failure. Int J Dermatol. 1992;31:860‐3.
Akhyani M, Ganji MR, Samadi N, Khamesan B, Daneshpazhooh M. Pruritus in hemodialysis patients. BMC Dermatol. 2005;5:7.
Udayakumar P, Balasubramanian S, Ramalingam KS, Lakshmi C, Shrinivas CR, Mathew AC. Cutaneous manifestations in patients with chronic renal failure on hemodialysis. Indian J Dermatol Venereol Leprol. 2006;72:119‐25.
Szepietowski JC, Schwartz RA. Uremic pruritus: Review. Int J Dermatol. 1998;37:247-53.
Sanad EM, Sorour NE, Saudi WM, Elmasry AM. Prevalence of cutaneous manifestations in chronic renal failure patients on regular hemodialysis: a hospital based study. Egyptian J Dermatol Venereol. 2014;34:27‐35.
Kaminski M, Frescos N, Tucker S. Prevalence of risk factors for foot ulceration in patients with end‐stage renal disease on haemodialysis. Intern Med J. 2012;42:120‐8.
Sultan MM, Mansour HH, Wahby IM, Houdery AS. Cutaneous manifestations in Egyptian patients with chronic renal failure on regular hemodialysis. J Egypt Women Dermatol Soc. 2010;7:49‐55.
Mourad B, Hegab D, Okasha K, Rizk S. Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt. Clin Cosmet Investig Dermatol. 2014;7:313‐9.
Rashpa RS, Mahajan VK, Kumar P, Mehta KS, Chauhan PS, Rawat R, et al. Mucocutaneous manifestations in patients with chronic kidney disease: A cross-sectional study. Indian Dermatol Online J. 2018;9:20-6.