Reduction of pruritus by increasing dialyzer rinsing solution in hemodialysis patients.

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概要

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• This study was undertaken to examine the correlation between degree of pruritus of hemodialysis patients and the quantity of dialyzer rinsing solution. In study 1, 15 patients undergoing dialysis treatment were examined regarding the severity of pruritus. The monthly total dose of antipruritic drugs (Glycyrrhizin, Neurotropin and Ketotifen fumarate) needed to treat the pruritus was measured under the use of 1500ml of rinsing solution. The patients were then compared with those under the use of 2000ml of rinsing solution. As a control group, 5 non-pruritic patients were also studied. Pruritus vanished in 7 patients, diminished in 5 and did not change in 3. Furthermore, the use of antipruritic drugs became unnecessary in 6 patients, decreased in 5, and remained unchanged in 4. During the period of observation, no pruritus developed in non-pruritic patients. In study 2, during the use of 2000ml of rinsing solution, the levels of IgE, histamine, C3a and somatostatin in the pruritic group (n=7) and non-pruritic group (n=8) were measured at three different time points (before dialysis, 15 minutes after and 4 hours after dialysis). The IgE level remained high throughout the three time points in the pruritic group. The histamine level was high before dialysis and was decreased 15 minutes after, but rose again 4 hours after in both groups. The C3a level was found to be slightly high in both groups 15 minutes after but much higher in the pruritic group, and the somatostatin level remained high in the pruritic group in each time point of dialysis. In study 3, the levels of IgE, histamine, C3a and somatostatin were measured after the use of 1000ml of rinsing solution and were compared with those after the use of 2000ml. The patients (4 pruritic and 3 non-pruritic patients) included in Study 3 were recruited from the patients included in Study 2. When treated with 2000ml of rinsing solution, the IgE level was found to be low. The histamine level showed no significant difference throughout the dialysis session. The C3a level rose high after 15 minutes, and the somatostatin level was significantly (p<0.05) lower than that with use of 1000ml solution in all stages. These studies suggest that pruritus may be induced by substances in dialyzer rinsing solutions that have a possible relation to IgE and somatostatin. We thus conclude that increase of rinsing solution volume may have beneficial effects on pruritic patients.

• 社団法人 日本透析医学会の論文

社団法人 日本透析医学会 | 論文

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