Dermatological Disorders in Chronic Kidney Disease

Authors

  • Aparna Shah Department of Dermatology, Shree Birendra Hospital, Kathmandu
  • Rajani Hada Department of Nephrology, National Academy of Medical Sciences, Bir Hospital, Kathmandu
  • Bhasker Mohan Mehar Kayastha Department of Dermatology, National Academy of Medical Sciences, Bir Hospital, Kathmandu,

DOI:

https://doi.org/10.31729/jnma.543

Abstract

Introduction: Dermatological conditions are common complications of Chronic Kidney Disease (CKD) affecting all most all patients. Present study aimed to evaluate the dermatological conditions and their association with age, sex and severity of CKD - without and with maintenance hemodialysis (MHD).

Methods: It is a cross sectional and comparative study. Eighty-three patients with established CKD, without MHD (n=35) and with MHD (n= 48), attending nephrology unit, Bir Hospital and Shree Birendra Hospital from June 2008 to May 2009 were examined for dermatological disorders.

Results: The mean age of patients were 46+15.6 years with male to female ratio of 1.8:1. Comparison of CKD without MHD and with MHD showed no statistical difference of age, sex, duration of treatment, blood urea and haemoglobin and significant difference of serum creatinine (5.3 + 3.0 mg/dl vs 9.1 + 4.5 mg/dl, p<0.001) respectively.

Dermatological conditions were found in 100% CKD patients with pallor 91.5%, xerosis 75.9%, pigmentary changes 65%, pruritus 60.2%, skin infection 36.9%, vascular changes 16.8%, mucosal changes 67.4%, hair changes 59%, non -specific nail changes 81.9% and specific nail changes14.4%,.

Specific (23.2% vs. 8.4%, p<0.03) and non- specific (91.4% vs 75%, p < 0.05) nail changes and hair abnormalities (74.3% vs. 47.9%, p<0.01) were significantly higher in CKD without MHD.

Conclusions: Dermatological conditions are present in all CKD patients with or without MHD. A further prospective study is necessary to find out pathophysiology and beneficial effect of dialysis and transplantation in these conditions.

Key words: chronic kidney disease, dermatological disorder, maintenance hemodialysis.

References

1. Pico MR, Lugo-Somolinos A, Sánchez JL, Burgos-Calderón R. Cutaneous alterations in patients with chronic renal failure. Int J Dermatol. 1992;31(12):860-3.
2. Udayakumar P, Balasubramanian S, Ramalingam KS, Chemboli L, Srinivas CR, Mathew AC. Cutaneous manifestation in patient with chronic renal failure on hemodialysis. Indian J Dermatol Venereol Leprol. 2006; 72:119-125.
3. Zucker I, Yosipovitch G, David M, Gafter U, Boner G. Prevalence and characterization of uremic pruritus in patients undergoing hemodialysis: uremic pruritus is still a major problem for patients with end-stage renal disease. J Am Acad Dermatol. 2003;49(5):842-6.
4. Narita I, Alchi B, Omori K, Sato F, Ajiro J, Saga D et al. Etiology and prognostic significance of uremic pruritus in chronic hemodialysis patients. Kidney Int. 2006;69:1626-32.
5. Hada R, Khakurel S, Agrawal RK. Kafle RK. Bajracharya SB and Raut KB. Incidence of end stage renal disease on renal replacement therapy in Nepal. Kathmandu University Medical Journal. 2009;7(3):301-305.
6. Hada R. End stage renal disease and renal replacement therapy- challenges and future prospective. Journal Nepal Med Assoc. 2009; 48(176):344-8.
7. Hada R, Khakurel S, Agrawal RK. Intact parathyroid hormone, calcium, phosphate and radiological changes in maintenance haemodialysis and newly diagnosed end stage renal disease patients. Bang Renal J. 2005;24 (1): 5-11.
8. Shrestha S, Ghotekar LR, Sharma SK, Shangwa PM, Karki P. Assessment of quality of life in patients of end stage renal disease on different modalities of treatment. J Nepal Med Assoc. 2008;47(169):1-6.
9. Amatya B, Agrawal S, Dhali T, Sharma S. Pattern of skin and nail changes in chronic renal failure in Nepal: Hospital-based study. Journal of Dermatology. 2008;35:140 -5.
10. Nurko S. Anemia in chronic kidney disease: causes, diagnosis, treatment. Cleveland Clinic Journal of Medicine. 2006 March;73(3):289-297.
11. Singh G, Verma AK, Singh G, Singh SJ. Cutaneous changes in chronic renal failure. Ind J Dermatol venereol Leprol. 1992;58 (5):320-2.
12. Jamal A, Subramaniam PT. Pruritus among end-stage renal failure patients on hemodialysis. Saudi J Kidney Disease and Transpl. 2000 April – June;11(2):181-5.
13. Akhyani M, Ganji MR, Samadi N, Khamesan B, Daneshpazhooh M. Pruritus in hemodialysis patients. BMC Dermatol. 2005;5:7.
14. Smith AG, Shuster S, Thody AJ, Alvarez-Ude F, Kerr DN. Role of the kidney in regulating plasma immunoreactive beta-melanocyte stimulating hormone. Br Med J. 1976;1:874-6.
15. Singh G, Singh SJ, Chakrabartht N, Siddharaju KS, Prakash JC. Cutaneous manifestations of chronic renal failure. Ind J Dermatol venereol Leprol. 1989;55:167-9.
16. Remuzzi G. Bleeding in Renal Failure. Lancet.1988;28:1205-8.
17. Galbusera M, Remuzzi G, Boccardo P. Treatment of bleeding in dialysis patients. Semin Dial. 2009 May-Jun;22(3):279-86.
18. Hajheydari Z, Makhlough A. Cutaneous and mucosal manifestations in patients on maintenance hemodialysis. A study of 101 patients in Sari, Iran. Iranian Journal of Kidney Diseases 2008;2:86-90.

Downloads

Published

2013-06-30

How to Cite

Shah, A., Hada, R., & Kayastha, B. M. M. (2013). Dermatological Disorders in Chronic Kidney Disease. Journal of Nepal Medical Association, 52(190). https://doi.org/10.31729/jnma.543

Issue

Section

Original Article