Cutaneous manifestations in patients with chronic kidney disease on hemodialysis

Authors

  • Saijal Gupta Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
  • Hemant V. Talanikar Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
  • Mahendra S. Deora Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
  • Ankita Agrawal Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
  • Yugal K. Sharma Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20210576

Keywords:

Chronic kidney disease, Hemodialysis, Xerosis, Pruritus, Acquired perforating dermatoses

Abstract

Background: Chronic kidney disease (CKD) is associated with several cutaneous manifestations as a result of CKD per se, underlying disease(s) leading to it or the treatment thereof. Cutaneous manifestations get altered following hemodialysis. We studied the prevalence of various dermatoses and the effect on pruritus in patients with CKD on hemodialysis.

Methods: Seventy-three patients with CKD having at least one cutaneous manifestation undergoing hemodialysis in Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune were included.

Results: Sixty-four (87.67%) of the participants belonged to the age group of 40-69 years; 28 (38.35%), to the sixth decade. The male to female ratio was 1.8:1. Forty-eight patients (65.75%) suffered from diabetes mellitus, 37 of these also from hypertension. Xerosis (72.6%), pallor (65.8%) and pruritus (60.3%) were the common manifestations. The intensity of pruritus remained unchanged in 82% of those affected. Nail changes were seen in 47.9% cases (half-and-half nail, 19.2%; subungual hyperkeratosis, 11%; leukonychia, 6.8%; melanonychia, 6.8%; Beau’s lines, 4.1%). Infections were observed in 32.8% cases (superficial mycoses, 19.2%; bacterial, 6.8%; scabies, 4.1%; viral, 2.7%). Dyspigmentation was documented in 30.1% (hyperpigmentation, 21.92%; yellow tinge, 8.22%), hair changes in 23.3% (sparse scalp hair,16.4%; lusterless hair, 6.9%), acquired perforating dermatoses in 19.2%, and arteriovenous shunt dermatitis in 2.7% cases.

Conclusions: Xerosis was the commonest finding and pruritus, the commonest symptom; the intensity of the latter remained largely unaffected by hemodialysis. Half-and-half nail was the most common nail change and superficial mycoses, the most common infection.

 

References

Mazuryk HA, Brodkin RH. Cutaneous clues to renal disease. Cutis 1991;47(4):241-48.

Singh G, Verma AK, Singh G, Singh SJ. Cutaneous changes in chronic renal failure. Indian J Dermatol Venereol Leprol. 1992;58:320-22.

Udayakumar P, Balasubramanian S, Ramalingam KS, Srinivas CR, Mathew AC. Cutaneous manifestations in patients with chronic renal failure on hemodialysis. Indian Dermatol Venereol Leprol. 2006;72:119-25.

Dyachenko P, Monselise A, Shustak A, Ziv M, Rozenman D. Nail disorders in patients with chronic renal failure and undergoing haemodialysis treatment: a case control study. J Eur Acad Dermatol Venereol. 2007;21:340-44.

Aramwit P, Supasyndh O. Uremic pruritus; its prevalence, pathophysiology and management. In: Suzuki H, editor. Updates in hemodialysis. London. In: TechOpen. 2015.

Mathur VS, Lindberg J, Germain M. A longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol. 2010;5:1410-419.

Narita I, Alchi B, Omori K. Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney Int. 2006;69:1626-632.

Sultan MM, Mansour HH, Wahby IM, Houdery AS. Cutaneous Manifestations in Egyptians Patients with Chronic Renal Failure on Regular Hemodialysis. J Egypt Women Dermatol Soc. 2010;7:49-55.

Usharani T, Kondabathini A. Cutaneous Manifestations in Chronic Renal Failure Patients on Hemodialysis. Int J Sci Stud. 2017;5(2):227-35.

Deshmukh SP, Sharma YK, Dash K, Chaudhari NC, Deo KS. Clinicoepidemiological study of skin manifestations in patients of chronic renal failure on hemodialysis. Indian Dermatol Online J. 2013;4(1):18-21.

Gilchrest BA, Rowe JW, Mihm MC. Bullous dermatosis of hemodialysis. Ann Intern Med. 1975;83:480-83.

Pico MR, Lugo-Somolinos A. Sanchez JL, Burgos-Calderon R. Cutaneous alterations in patients with chronic renal failure. Int J Dermatol. 1992;31:860-863.

Jamal A, Subramanian PT. Pruritus among End-Stage renal failure patients on Hemodialysis. Saudi J Kidney Dis Tranpl. 2000;11:181-5.

Morton CA, Lafferty M, Hau C, Henderson I, Jones M, Lowe JG. Pruritus and skin hydration during dialysis. Nephron Dial Transplant 1996;11:2031-6.

Gupta AK, Gupta MA, Cardella CJ, Haberman HF. Cutaneous associations of chronic renal failure and dialysis. Int J Dermatol 1986;25(8):498-504.

Kato A, Hamada M, Maruyama Y, Hishida A. Pruritus and hydration state of stratum corneum in hemodialysis patients. Am J Nephrol 200:20:437-42.

Nielsen T, Andersen KE, Kristiansen J. Pruritus and xerosis in patients with chronic renal failure. Dan Med Bull 1980;27:269-71.

Tawade N, Gokhale BB. Dermatologic manifestation of chronic failure. Indian J Dermatol Venereol Leprol 1996;62:155-6.

Sidappa K, Nair BK, Ravindra K, Siddhesh ER. Skin in systemic disease. In: Vali RG, Valia AR, editors. IADVL Textbook and atlas of dermatology. 2nd ed. Bhalani Publishing House: Mumbai;2000;p.938-84.

Cawley EP, Hoch-Bigeti C, Bondy GM. The eccrine sweat glands of patients in uraemia. Arch Dermatol 1961;84:889

Vahlquist A, Berne B. Bere C. Skin content and plasma transport of Vitamin A and B- carotene in Chronic Renal Failure. Eur J Clin Invest 1982:12:63-67.

Szepietowski JC, Reich A, Schwartz RA. Uraemic Xerosis. Nephrol Dial Transplant 2044;19:2709-2712.

Bencini PL, Montagnino G, Citterio A, Graziani G, Crosti C, Ponticelli C. Cutaneous abnormalities in uremic patients. Nephron 1985:50:316-21.

Weisman K, Graham RM. Systemic disease and the skin. In: Champion RH, Burton JL, Burns DA. Breathnach SM, editors. Rook/ Wilkinson/ Ebling Textbook of dermatology. 6th ed. Blackwell Science: Oxford; 1998. p. 2703-58.

Graham RM, Cox NH. Systemic disease and the skin. In: Burns DA, Breathnach SM, Cox N, Griffiths CE, editors. Rook's textbook of dermatology. 7th ed.: Wiley-Blackwell; 2004. p. 59-75.

Smith AG, Shuster S, Comaish JS, Plummer NA, Thody AJ, Alvarez-ude F. Plasma immunoreactive B-Melanocyte stimulating Hormone and Skin Pigmentation in Chronic Renal Failure. Br Med J 1975;1:658-659.

Sweeny S, Cropley TG. Cutaneous changes in renal disorders. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, editors. Fitzpatrick´s Dermatology in General Medicine. 6th ed. New York, McGraw-Hill; 2003. p. 1622 - 34.

Comaish JS, Ashcroft T, Kerr DNS. The pigmentation of chronic renal failure. Acta Dermato-Venereol 1975; 55: 215 - 7.

Heilman ER, Friedman RJ. Degenerative diseases and perforating disorders. In: Elder D, Elenitsas R, Jaworsky C, Johnson Jr. B, editors. Lever's histopathology of the skin. 8th ed. Lippincott-Raven: Philadelphia; 1997. p. 341-51.

Headley CM, Wall B. ESRD-associated cutaneous manifestations in a hemodialysis population. Nephrol Nurs J 2002;29:525-39.

Brenner BM, Lazarus JM. Chronic renal failure. In: Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL, editors. Harrison's Principles of internal medicine. 13th ed. New York: McGraw-Hill; 1994. p. 1274-81.

Goh GL, Phay KL. Arterio-venous shunt dermatitis in chronic renal failure patients on hemodialysis. Clin Exp Dermatol 1988;13:1038-40.

Raymond GG, Saenz RV, Chandler C. Drug induced skin manifestations. US Pharmacist 1978;3:44-8.

Levine JM, Taylor RA, Elman LB, Bird SJ, Lavi E, Stolzenberg ED, et al. Involvement of skeletal muscle in dialysis-associated systemic fibrosis (nephrogenic fibrosing dermopathy). Muscle Nerve 2004;30:569-77.

Downloads

Published

2021-02-22

Issue

Section

Original Research Articles