The Experts below are selected from a list of 453 Experts worldwide ranked by ideXlab platform
Geoffrey Boner - One of the best experts on this subject based on the ideXlab platform.
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prevalence and characterization of Uremic Pruritus in patients undergoing hemodialysis Uremic Pruritus is still a major problem for patients with end stage renal disease
Journal of The American Academy of Dermatology, 2003Co-Authors: Inbar Zucker, Gil Yosipovitch, Michael David, Uzi Gafter, Geoffrey BonerAbstract:Abstract Background Pruritus is a common disabling problem in patients with advanced end-stage renal disease. Few studies have evaluated the clinical characteristics of Uremic itch. Objectives The aim of this multicenter study was to provide a comprehensive description of the prevalence and clinical characteristics of Pruritus affecting patients with end-stage renal disease who are undergoing hemodialysis. Methods A detailed questionnaire recently developed was used to evaluate Pruritus in 219 patients undergoing hemodialysis treatment in 3 dialysis units. We examined the relationship of the quality of dialysis and various factors and medical parameters to itch. Results Pruritus was a common symptom in the study population. Approximately 66% of the patients had Pruritus at some point, and 48% were affected by it at the time of the study. There was no correlation between the occurrence of Pruritus and demographic or medical parameters (type of kidney disease, medical management, dialysis efficacy as expressed by Kt/V) of the patient. The data suggest that Uremic Pruritus tends to be prolonged, frequent, and intense, and it can impair the patient's quality of life including a negative effect on sleep and mood. Major factors found to exacerbate Pruritus include rest, heat, dry skin, and sweat. Major factors found to reduce Pruritus include activity, sleep, hot and cold shower, and cold. Treatment with angiotensin inhibitors seemed to be more common among those with uremia who had itch ( P = .02) whereas furosemide was more commonly used among those who never itched ( P = .002). Conclusion This study provides a detailed description of Uremic Pruritus with new data on its characteristics including affective and sensory dimensions and associated symptoms.
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a questionnaire for the assessment of Pruritus validation in Uremic patients
Acta Dermato-venereologica, 2001Co-Authors: Gil Yosipovitch, Inbar Zucker, Uzi Gafter, Geoffrey Boner, Yonathan Shapira, Michael DavidAbstract:suggest that Uremic Pruritus tends to be prolonged, frequently speaking subject was approached by a single investigator (IZ) and intense and a major source of distress to the patient. Dialysis asked to agree to complete the questionnaire during a personal was not found to ine uence the Pruritus. The questionnaire may interview after giving informed consent. itch: questionnaire, Uremic Pruritus. appearing in conjunction with signiecant deterioration in renal function or during dialysis with no evidence of another disease that could
Akio Mori - One of the best experts on this subject based on the ideXlab platform.
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kappa opioid system in Uremic Pruritus multicenter randomized double blind placebo controlled clinical studies
Journal of The American Society of Nephrology, 2005Co-Authors: Bjorn Wikstrom, Ryszard Gellert, Soren Ladefoged, Yasuaki Danda, Masahiko Akai, Kaoru Ide, Midori Ogasawara, Yoshiharu Kawashima, Koki Ueno, Akio MoriAbstract:Uremic Pruritus is a very common and frustrating condition for both patients and clinicians because no treatment has been demonstrated to be effective in relieving the itch. In this report, nalfurafine, a new kappa-opioid receptor agonist, was used to treat Uremic Pruritus in patients who were undergoing routine hemodialysis. Two multicenter, randomized, double-blind, placebo-controlled studies enrolled 144 patients with Uremic Pruritus to postdialysis intravenous treatment with either nalfurafine or placebo for 2 to 4 wk. A meta-analysis approach was used to assess the efficacy of nalfurafine. Statistically significant reductions in worst itching (P = 0.0212), itching intensity (P = 0.0410), and sleep disturbances (P = 0.0003) were noted in the nalfurafine group as compared with placebo. Improvements in itching (P = 0.0025) and excoriations (P = 0.0060) were noted for the nalfurafine-treated patients. Nalfurafine showed similar types and incidences of drug-related adverse events as did placebo. Nalfurafine was shown to be an effective and safe compound for use in this severely ill patient population.
Wan Ting Chiu - One of the best experts on this subject based on the ideXlab platform.
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therapeutic effect of topical gamma linolenic acid on refractory Uremic Pruritus
American Journal of Kidney Diseases, 2006Co-Authors: Yung Chih Chen, Wan Ting ChiuAbstract:Background: Pruritus is a bothersome symptom affecting up to 80% of dialysis patients. Lymphocyte and cytokine interaction has an important role in the pathogenesis of Uremic Pruritus. Gamma-linolenic acid (GLA) is associated with immune modulation of T lymphocytes and lymphokines. The aim of this study is to determine whether topical GLA can attenuate Uremic Pruritus. Methods: Seventeen dialysis patients with refractory Uremic Pruritus who passed the screening criteria entered a prospective, randomized, double-blind, placebo-controlled, crossover study. They stopped all antipruritic therapy at least 2 weeks before the study and were randomly assigned to treatment with either GLA 2.2% cream or placebo-based cream applied to the entire body after taking a bath once a day and to pruritic sites 3 times a day for 2 weeks, and then the reverse treatment after a 2-week washout period. Severity of Pruritus was evaluated by using a traditional visual analogue scale (VAS) and a modified questionnaire method (Pruritus score [PS]). Hemogram, aspartate and alanine aminotransferases, bilirubin, albumin, blood urea nitrogen, creatinine, calcium, phosphate, and intact parathyroid hormone were measured. Results: Sixteen patients completed the study; 1 patient was withdrawn because of an allergic skin reaction. There were no significant differences between groups except for sex distribution. Median VAS and PS values between groups did not differ significantly at baseline. There is a greater antipruritic effect of GLA based on evaluation with both the VAS and PS. There is persistence of a residual effect into the second treatment period after GLA treatment. Conclusion: GLA-rich cream is better than placebo-based cream for alleviating Uremic Pruritus. It is a useful adjuvant in the management of refractory Uremic Pruritus.
Vandana S Mathur - One of the best experts on this subject based on the ideXlab platform.
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a multicenter randomized double blind placebo controlled trial of nalbuphine er tablets for Uremic Pruritus
American Journal of Nephrology, 2017Co-Authors: Vandana S Mathur, Jayant Kumar, Paul W Crawford, Howard Hait, Thomas Sciascia, Tr Study InvestigatorsAbstract:Background: Pruritus is a distressing hallmark of the Uremic condition, affecting approximately 60% of hemodialysis patients. Abnormal endogenous opioid ligand activity at μ and κ-opioid receptors has been postulated as a mechanism in Uremic Pruritus. Nalbuphine is a μ-opioid antagonist and κ-opioid agonist. Methods: In this multicenter, randomized, double-blind, placebo-controlled trial, 373 hemodialysis patients with moderate or severe Uremic Pruritus were randomized in a 1: 1:1 ratio to nalbuphine extended-release tablets 120 mg (NAL 120), 60 mg (NAL 60), or placebo and treated for 8 weeks. Three hundred seventy-one were analyzed for efficacy. The primary endpoint was the change from baseline to treatment weeks 7 and 8 in itching intensity on a Numerical Rating Scale (NRS, 0 [no itching]; 10 [worst possible itching]) using an intent-to-treat approach. The aim was to evaluate the safety and antipruritic efficacy of NAL. Results: The mean duration of itching was 3.2 years. From a baseline NRS of 6.9 (1.5), the mean NRS declined by 3.5 (2.4) and by 2.8 (2.2) in NAL 120 mg and the placebo groups, respectively ( p = 0.017). There was no evidence of tolerance. A trend for less sleep disruption due to itching ( p = 0.062, NAL 120 vs. placebo) was also observed. There were no significant differences between NAL 60 vs. placebo. Serious adverse events occurred in 6.7, 12.7, and 15.4% in the NAL 120, NAL 60, and placebo groups respectively. Conclusions: In this largest-to-date randomized controlled trial in Uremic Pruritus, NAL 120 durably and significantly reduced the itching intensity among hemodialysis patients.
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a longitudinal study of Uremic Pruritus in hemodialysis patients
Clinical Journal of The American Society of Nephrology, 2010Co-Authors: Vandana S Mathur, Jill S Lindberg, Michael J Germain, Geoffrey A Block, James A Tumlin, Mark W Smith, Mandeep Grewal, Dawn McguireAbstract:Background and objectives: Although Uremic Pruritus (UP) is a highly prevalent complication of chronic kidney disease, it remains poorly characterized. There have been no longitudinal studies of natural history, and no health-related quality of life (HR-QOL) instruments have been developed for UP. The objectives of this study were to describe the natural history of UP, to compare rating scales of itching intensity, and to assess usefulness and validity of HR-QOL instruments for UP. Design, setting, participants, & measurements: The intensity, severity, and effects of pathologic itching on HR-QOL were assessed prospectively in 103 patients with UP on chronic hemodialysis. Outcome measures were obtained at scheduled intervals over 3.5 months. Results: Itching daily or nearly daily was reported by 84% of patients and had been ongoing for >1 year in 59%. In 83%, Pruritus involved large, nondermatomal areas with striking bilateral symmetry. Two thirds of the patients were using medications such as antihistamines, steroids, and various emollients without satisfactory relief of itching. Statistically significant associations were found among itching intensity, severity, and HR-QOL measures in domains such as mood, social relations, and sleep. Among patients with moderate-to-severe UP, changes in itching intensity of 20% or greater were associated with significant reductions in HR-QOL measures. Conclusions: This first longitudinal study of UP describes key features of UP and its effect on HR-QOL. The assessment instruments we have developed are easily used, are responsive to changes in UP intensity, and should facilitate clinical evaluation and research to meet the needs of afflicted patients.
Alberto Giannetti - One of the best experts on this subject based on the ideXlab platform.
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Cutaneous innervation in chronic renal failure patients. An immunohistochemical study.
Acta dermato-venereologica, 1992Co-Authors: Fabrizio Fantini, A. Baraldi, Cinzia Sevignani, A. Spattini, Carlo Pincelli, Alberto GiannettiAbstract:Most chronic renal failure patients suffer from generalized Pruritus. An involvement of cutaneous nerve terminals in the pathogenesis of Uremic Pruritus has been suggested. Skin specimens from 24 Uremic patients and 10 healthy subjects were processed with an indirect immunofluorescence method to investigate the presence and distribution of a number of neuronal markers and neuropeptides. No difference was found between the two groups in the distribution pattern of the positive nerve fibres. However, a reduction in the total number of skin nerve terminals in the Uremic patients was detected. No correlation could be found between the immunohistochemical findings and the clinical features. Our results suggest that the skin innervation is altered in most chronic renal failure patients, possibly as a consequence of neuropathy.
