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Endocrine, Metabolic & Immune Disorders - Drug Targets

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ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

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Research Article

Relationship between Subclinical Hypothyroidism and Uremic Pruritis in Hemodialysis Patients

Author(s): Essam Kotb*, Ismail Mohamed El mancy, Ibrahim Ghounim Ramadan Mohamed, Hazem Sayed Ahmed Ayoub, AL-Sayed M. Rashed, Waleed S. EL-Nasser, Hani Ismail Hamed, Hossam Aladl Aladl, Mostafa Sabrh, Ahmed Eliwa, Esam M. Ghamry, Mohamed R. Abdelhamed and Tamer M. Mahmoud

Volume 24, Issue 2, 2024

Published on: 23 June, 2023

Page: [235 - 241] Pages: 7

DOI: 10.2174/1871530323666230509103021

Price: $65

Abstract

Background and Aim: Uremic pruritus (UP) is one of the most distressing symptoms in hemodialysis (HD) patients. Subclinical hypothyroidism (SCH) is a biochemical condition with high prevalence in HD patients. The present multicentric study aimed to assess the relationship between UP and SCH in HD patients.

Methods: The present cross-sectional study included 328 HD patients. All patients were submitted to careful history through clinical examination and standard laboratory assessment. Pruritis was evaluated using the pruritis visual analog scale (VAS). Patients were diagnosed with SCH if they had TSH levels above the upper limit of the normal reference range in association with normal free thyroxine (FT4) levels.

Results: Among the studied patients, there were 196 patients (59.8 %) with UP. Comparison between patients with UP and patients without revealed that patients in the former group had significantly longer HD duration (median (IQR): 47.5 (27.0-72.5) versus 36.0 (23.0-50.5) months, p < 0.001) and lower Kt/v (median (IQR): 1.4 (1.09-1.7) versus 1.54 (1.12-1.91), p = 0.009). Moreover, they had significantly higher ferritin (median (IQR): 653.0 (526.0-800.0) versus 628.0 (470.8- 716.0) ng/mL), hsCRP (median (IQR): 12.0 (8.0-14.0) versus 8.0 (6.0-9.0) mg/dL, p < 0.001) and TSH levels (median (IQR): 4.34 (1.98-5.2) versus 3.34 (1.9-4.85) μIU/ml) with a significantly higher frequency of SCH (45.9 % versus 28.8 %, p = 0.002). Logistic regression analysis identified hemodialysis duration (OR (95%) CI): 1.02 (1.009-1.028), p < 0.001), ferritin levels (OR (95% CI): 1.002 (1.001-1.003), p < 0.001), and SCH (OR (95% CI): 0.54 (0.32-0.89), p = 0.016) as significant predictors of UP.

Conclusion: The present study suggested a possible link between SCH and the development of UP in HD patients.

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[1]
Hu, X.; Sang, Y.; Yang, M.; Chen, X.; Tang, W. Prevalence of chronic kidney disease-associated pruritus among adult dialysis patients. Medicine, 2018, 97(21), e10633.
[http://dx.doi.org/10.1097/MD.0000000000010633] [PMID: 29794739]
[2]
Kim, D.; Pollock, C. Epidemiology and burden of chronic kidney disease-associated pruritus. Clin. Kidney J., 2021, 14(S3), i1-i7.
[http://dx.doi.org/10.1093/ckj/sfab142] [PMID: 34987777]
[3]
Rehman, I.U.; Chohan, T.A.; Bukhsh, A.; Khan, T.M. Impact of pruritus on sleep quality of hemodialysis patients: A systematic review and meta-analysis. Medicina, 2019, 55(10), 699.
[http://dx.doi.org/10.3390/medicina55100699] [PMID: 31627446]
[4]
Poku, E.; Harnan, S.; Rooney, G.; James, M.M.S. Hernández-Alava, M.; Schaufler, T.; Thokala, P.; Fotheringham, J. The relationship between chronic kidney disease–associated pruritus and health-related quality of life: A systematic review. Clin. Kidney J., 2022, 15(3), 484-499.
[http://dx.doi.org/10.1093/ckj/sfab218] [PMID: 35211305]
[5]
Reszke, R.; Szepietowski, J.C. End-stage renal disease chronic itch and its management. Dermatol. Clin., 2018, 36(3), 277-292.
[http://dx.doi.org/10.1016/j.det.2018.02.007] [PMID: 29929599]
[6]
Arzhan, S.; Roumelioti, M.E.; Unruh, M.L. Itch and ache on dialysis: New approaches to manage uremic pruritus and restless legs. Blood Purif., 2020, 49(1-2), 222-227.
[http://dx.doi.org/10.1159/000504081] [PMID: 31851986]
[7]
Hercz, D.; Jiang, S.H.; Webster, A.C. Interventions for itch in people with advanced chronic kidney disease. Cochrane Libr., 2020, 2020(12), CD011393.
[http://dx.doi.org/10.1002/14651858.CD011393.pub2] [PMID: 33283264]
[8]
Lipman, Z.M.; Paramasivam, V.; Yosipovitch, G.; Germain, M.J. Clinical management of chronic kidney disease-associated pruritus: Current treatment options and future approaches. Clin. Kidney J., 2021, 14(S3), i16-i22.
[http://dx.doi.org/10.1093/ckj/sfab167] [PMID: 34987779]
[9]
Trachtenberg, A.J.; Collister, D.; Rigatto, C. Recent advances in the treatment of uremic pruritus. Curr. Opin. Nephrol. Hypertens., 2020, 29(5), 465-470.
[http://dx.doi.org/10.1097/MNH.0000000000000625] [PMID: 32740217]
[10]
Ahdoot, R.S.; Kalantar-Zadeh, K.; Burton, J.O.; Lockwood, M.B. Novel approach to unpleasant symptom clusters surrounding pruritus in patients with chronic kidney disease and on dialysis therapy. Curr. Opin. Nephrol. Hypertens., 2022, 31(1), 63-71.
[http://dx.doi.org/10.1097/MNH.0000000000000752] [PMID: 34750335]
[11]
Biondi, B.; Cappola, A.R.; Cooper, D.S. Subclinical hypothyroidism. JAMA, 2019, 322(2), 153-160.
[http://dx.doi.org/10.1001/jama.2019.9052] [PMID: 31287527]
[12]
Gong, N.; Gao, C.; Chen, X.; Fang, Y.; Tian, L. Endothelial function in patients with subclinical hypothyroidism: A meta-analysis. Horm. Metab. Res., 2019, 51(11), 691-702.
[http://dx.doi.org/10.1055/a-1018-9564] [PMID: 31683338]
[13]
Delitala, A.P.; Scuteri, A.; Maioli, M.; Mangatia, P.; Vilardi, L.; Erre, G.L. Subclinical hypothyroidism and cardiovascular risk factors. Minerva Med., 2020, 110(6), 530-545.
[http://dx.doi.org/10.23736/S0026-4806.19.06292-X] [PMID: 31726814]
[14]
Ehsanzadeh-Cheemeh, P.; Thompson, M.; Miller, M. Subclinical hypothyroidism and homeostatic disturbances: case report and literature review. Recent Pat. Endocr. Metab. Immune Drug Discov., 2012, 6(2), 136-138.
[http://dx.doi.org/10.2174/187221412800604590] [PMID: 22435391]
[15]
Danicic, J.M.; Inder, W.J.; Kotowicz, M.A. Impact of subclinical hypothyroidism on health‐related quality of life: A narrative review. Intern. Med. J., 2021, 51(9), 1380-1387.
[http://dx.doi.org/10.1111/imj.15431] [PMID: 34139046]
[16]
Da Costa, A.B.B.A.; Pellizzari, C.; Carvalho, G.A.; Sant’Anna, B.C.; Montenegro, R.L.; Zammar, F. R.G.; Mesa J., C.O.; Hauck Prante, P.R.; Olandoski, M.; Carvalho, M. High prevalence of subclinical hypothyroidism and nodular thyroid disease in patients on hemodialysis. Hemodial. Int., 2016, 20(1), 31-37.
[http://dx.doi.org/10.1111/hdi.12339] [PMID: 26246426]
[17]
Pakfetrat, M.; Dabbaghmanesh, M.H.; Karimi, Z.; Rasekhi, A.; Malekmakan, L.; Hossein, N.M. Prevalence of hypothyroidism and thyroid nodule in chronic hemodialysis Iranian patients. Hemodial. Int., 2017, 21(1), 84-89.
[http://dx.doi.org/10.1111/hdi.12453] [PMID: 27364542]
[18]
Dhrolia, M.F.; Naseem, F.; Mannan, A.; Imtiaz, S.; Qureshi, R.; Ahmed, A. Prevalence of subclinical hypothyroidism in patients with chronic kidney disease on maintenance hemodialysis. Saudi J. Kidney Dis. Transpl., 2018, 29(4), 846-851.
[http://dx.doi.org/10.4103/1319-2442.239646] [PMID: 30152421]
[19]
Ellervik, C.; Mora, S.; Ridker, P.M.; Chasman, D.I. Hypothyroidism and kidney function: A mendelian randomization study. Thyroid, 2020, 30(3), 365-379.
[http://dx.doi.org/10.1089/thy.2019.0167] [PMID: 31910748]
[20]
Yuasa, R.; Ohashi, Y.; Saito, A.; Tsuboi, K.; Shishido, S.; Sakai, K. Prevalence of hypothyroidism in Japanese chronic kidney disease patients. Ren. Fail., 2020, 42(1), 572-579.
[http://dx.doi.org/10.1080/0886022X.2020.1777162] [PMID: 32567453]
[21]
Reque, S.J.; Garcia, P.B.; Panizo, G.N.; Perez, A.A.; D’Marco, L.; Collado, B.E. Subclinical hypothyroidism in advanced chronic kidney disease patients: Prevalence and associated factors. J. Thyroid Res., 2022, 2022, 1077553.
[http://dx.doi.org/10.1155/2022/1077553] [PMID: 35620417]
[22]
Tsuda, S.; Nakayama, M.; Matsukuma, Y.; Yoshitomi, R.; Haruyama, N.; Fukui, A.; Nakano, T.; Tsuruya, K.; Kitazono, T. Subclinical hypothyroidism is independently associated with poor renal outcomes in patients with chronic kidney disease. Endocrine, 2021, 73(1), 141-150.
[http://dx.doi.org/10.1007/s12020-021-02611-6] [PMID: 33474711]
[23]
Reich, A.; Heisig, M.; Phan, N.; Taneda, K.; Takamori, K.; Takeuchi, S.; Furue, M.; Blome, C.; Augustin, M.; Ständer, S.; Szepietowski, J. Visual analogue scale: Evaluation of the instrument for the assessment of pruritus. Acta Derm. Venereol., 2012, 92(5), 497-501.
[http://dx.doi.org/10.2340/00015555-1265] [PMID: 22102095]
[24]
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), 842-846.
[http://dx.doi.org/10.1016/S0190-9622(03)02478-2] [PMID: 14576662]
[25]
Rehman, I.U.; Munib, S.; Ramadas, A.; Khan, T.M. Prevalence of chronic kidney disease-associated pruritus, and association with sleep quality among hemodialysis patients in Pakistan. PLoS One, 2018, 13(11), e0207758.
[http://dx.doi.org/10.1371/journal.pone.0207758] [PMID: 30496235]
[26]
Daraghmeh, M.; Badran, M.; Janajreh, A.; Hassan, M.; Taha, A.A.; Koni, A.A.; Zyoud, S.H. Prevalence of pruritus associated with hemodialysis and its association with sleep quality among hemodialysis patients: A multicenter study. BMC Nephrol., 2022, 23(1), 213.
[http://dx.doi.org/10.1186/s12882-022-02838-z] [PMID: 35715758]
[27]
Ko, M.J.; Peng, Y.S.; Chen, H.Y.; Hsu, S.P.; Pai, M.F.; Yang, J.Y.; Wen, S.Y.; Jee, S.H.; Wu, H.Y.; Chiu, H.C. Interleukin-31 is associated with uremic pruritus in patients receiving hemodialysis. J. Am. Acad. Dermatol., 2014, 71(6), 1151-1159.e1.
[http://dx.doi.org/10.1016/j.jaad.2014.08.004] [PMID: 25270263]
[28]
Sayadi, M.; Pakfetrat, M.; Sepaskhah, M.; Roozbeh, J.; Malekmakan, L.; Malekmakan, A. Association of high-sensitive C-reactive protein and dialysis adequacy with uremic pruritus. Saudi J. Kidney Dis. Transpl., 2015, 26(5), 890-895.
[http://dx.doi.org/10.4103/1319-2442.164565] [PMID: 26354559]
[29]
Wu, H.Y.; Huang, J.W.; Tsai, W.C.; Peng, Y.S.; Chen, H.Y.; Yang, J.Y.; Hsu, S.P.; Pai, M.F.; Ko, M.J.; Hung, K.Y.; Chiu, H.C. Prognostic importance and determinants of uremic pruritus in patients receiving peritoneal dialysis: A prospective cohort study. PLoS One, 2018, 13(9), e0203474.
[http://dx.doi.org/10.1371/journal.pone.0203474] [PMID: 30183756]
[30]
Tawfik, M.; Fathy, N.; Mousa, A.A.; Ghonem, M.; Abdelsalam, M. Thyroid dysfunction and insulin resistance in end‐stage renal disease patients before and 1 year after starting maintenance hemodialysis: A prospective multicenter study. Semin. Dial., 2022, 35(2), 138-145.
[http://dx.doi.org/10.1111/sdi.13044] [PMID: 34881448]
[31]
Abdelsalam, M.; Tawfik, M.; Reda, E.M.; Eldeeb, A.A.; Abdelwahab, A.; Zaki, M.E.; Abdelkader, S.M. Insulin resistance and hepatitis c virus-associated subclinical inflammation are hidden causes of pruritus in egyptian hemodialysis patients: A multicenter prospective observational study. Nephron J., 2019, 143(2), 120-127.
[http://dx.doi.org/10.1159/000501409] [PMID: 31311030]
[32]
Liu, M.H.; Chan, M.J.; Hsu, C.W.; Weng, C.H.; Yen, T.H.; Huang, W.H. Association of uremic pruritus in hemodialysis patients with the number of days of high mean 24-hour particulate matter with a diameter of <2.5 μm. Ther. Clin. Risk Manag., 2017, 13, 255-262.
[http://dx.doi.org/10.2147/TCRM.S129133] [PMID: 28260912]

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