Pruritus and the Quality of Life in Patients with Chronic Kidney Disease Stage VD Treated by Hemodialysis

Introduction. The problem of the quality of life of patients with the chronic kidney disease stage VD treated by hemodialysis is becoming more and more urgent in medicine. One of the most common factors that worsen in patients with chronic kidney disease (CKD) that are treated by hemodialysis – skin itching occurs in 50.0-60.0% of these patients. Itching affects sleep, working capacity, causes depression, sometimes suicidal thoughts. Aim. To increase the efficiency of treatment of patients with CKD and skin itching, which are treated by hemodialysis, with the use of ultraviolet irradiation on the basis of the study of the effect of skin itching on the quality of their life, the state of decomposing cells and proinflammatory cytokines. Materials and methods. The study involved 109 patients with CKD of the VD stage who were undergoing hemodialysis at the Lviv Regional Clinical Hospital and Kyiv City Scientific and Practical Center of Nephrology and Dialysis. The control group was made up of 20 healthy individuals who, according to age and gender, corresponded to the patients of the examined group. There were studied the parameters of the pruritus, the quality of life, the levels of proinflammatory cytokines (IL-1β, IL-17, MCP-1), the presence and activity of the skin mast cells, depending on the presence / absence of the itching skin. Was carried out the ultraviolet radiation treatment and was examined its effect on the itching, the levels of cytokines and the quality of life in 109 hemodialysis patients. Results. In 56.0 % of patients with the chronic kidney disease stage VD was revealed the skin itching which is inversely correlated with the most indicators of the life quality. Proinflammatory cytokines potentially reflect the activity of pruritus in 58.3 % of patients. Was noted a higher number and activity of mast cells in patients with the pruritus compared to patients without it. As a result of the comparisons between proinflammatory cytokines and mast cells was found a direct connection of both in patients with the pruritus. In 100.0 % of patients the ultraviolet radiation treatment helped to eliminate the skin itching. The positive influence of the ultraviolet radiation retained in 45.8 % of patients within one year. The levels of the proinflammatory cytokines in patients with the pruritus decreased in two weeks after the ultraviolet radiation course. Conclusions. It was found that in patients with the CKD stage VD treated by the hemodialysis the itching of the skin significantly impairs the quality of life. It was also found that the ultraviolet radiation treatment reduced the itching of the skin in these patients, resulting in the improvement of the quality of life by 14.8 %.