背景:与慢性肾脏疾病相关的瘙痒被定义为瘙痒感,在慢性肾病患者中,在一个区域或整个身体导致需要划伤,在排除了其他皮肤病或全身原因后。这是一个古老而已知的问题,其患病率随着透析技术的改进而降低,但仍然存在并且未被诊断。
目的:本研究的目的是通过一项调查分析肾脏科医师对这个影响慢性肾脏病患者生活质量的问题的当前看法。
结果:135名肾病学家,他们中的大多数从事血液透析,参与。86%的人认为与慢性肾脏疾病相关的瘙痒仍然是影响生活质量的问题。大多数肾病学家认为主要的病理生理原因是尿毒症毒素(60%),只有16%的人认为这是由于阿片样物质系统/内啡肽-强啡肽的失调所致。只有16%的人评论他们中心的瘙痒患病率大于20%。40%的人认为诊断是因为它是由患者表现出来的,只有27%的人认为是由医生询问的。此外,通常不使用量表来测量它或在医疗记录中进行编码。使用的主要治疗方法是抗组胺药(96%),其次是保湿剂/麻醉剂(93%)和透析方案的修改(70%)。
结论:与慢性肾脏疾病相关的瘙痒仍然是当前的问题,它被诊断不足,没有编纂,也没有标明,有效和安全的治疗。肾脏科医师不知道其真正的患病率和参与其发展的不同病理生理机制。许多治疗方案的使用具有非常不同的结果,忽视了它们在目前的有效性和适用性。新兴的κ阿片受体激动剂为我们提供了重新评估这个古老问题的机会,并改善了慢性肾病患者的生活质量。
Pruritus associated with chronic kidney disease is defined as the sensation of itching, in people with chronic kidney disease, in a one area or all over the body that causes the need to scratch, after having ruled out other dermatological or systemic causes. It is an old and known problem whose prevalence has been able to decrease with the improvement of dialytic techniques but which still persists and is underdiagnosed.
The objective of this study was to analyse the current perception of nephrologists about this problem that influences the quality of life of people with chronic kidney disease through a survey.
135 nephrologists, most of them engaged in haemodialysis, participated. 86% considered that pruritus associated with chronic kidney disease is still a problem today that affects the quality of life. Most nephrologists believe that the main pathophysiological cause is uremic toxins (60%) and only 16% believe that it is due to the dysregulation of the opioid system/endorphins-dynorphins. Only 16% comment that the prevalence of pruritus in their centre is greater than 20%. 40% believe that the diagnosis is made because it is manifested by the patient and only 27% because it is asked by the doctor. Moreover, it is not usual to use scales to measure it or the codification in the medical records. The main treatment used is antihistamines (96%), followed by moisturizers/anaesthetics (93%) and modification of the dialysis regimen (70%).
Pruritus associated with chronic kidney disease is still a current problem, it is underdiagnosed, not codified and with a lack of indicated, effective and safe treatments. Nephrologists do not know its real prevalence and the different pathophysiological mechanisms involved in its development. Many therapeutic options are used with very variable results, ignoring their efficacy and applicability at the present time. The new emerging kappa-opioid-receptor agonist agents offer us an opportunity to reevaluate this age-old problem and improve the quality of life for our patients with chronic kidney disease.