Manejo eficiente del prurito con emolientes y gabapentina en el paciente urémico y su impacto en la calidad de vida
Palabras clave:
: insuficiencia renal crónica terminal, diálisis peritoneal, hemodiálisis, prurito, gabapentín, emolientesResumen
Introducción. Entre los síntomas que con mayor frecuencia presentan los pacientes con enfermedad renal crónica terminal en la terapia de reemplazo renal de tipo hemodiálisis y diálisis peritoneal, se encuentra el prurito urémico.
Objetivo. Comparar la efectividad de los emolientes con la de la gabapentina en el manejo del prurito urémico y el impacto en la calidad de vida en los pacientes con enfermedad renal crónica terminal en terapia de reemplazo renal de tipo hemodiálisis y diálisis peritoneal, en el Servicio de Terapia Renal del Hospital Pablo Tobón Uribe, entre enero y abril de 2010.
Metodología. Se realizó un ensayo clínico controlado de asignación aleatoria, sin cegamiento, en el que se administraron tratamientos con emolientes o gabapentina a grupos de pacientes con insuficiencia renal crónica y prurito, que acudieron al Servicio de Terapia Renal del Hospital Pablo Tobón Uribe, para recibir terapia de reemplazo renal, ya fuera hemodiálisis o diálisis peritoneal.
Resultados. En ambos grupos se observó mejoría sustancial del prurito. En 15 pacientes que fueron tratados con gabapentina, se encontró una disminución de la intensidad del prurito, medido por la escala visual análoga, pasando de una media de 6,6 al inicio a una de 1,1 al final. Del mismo modo ocurrió con los 18 pacientes del grupo que recibió emolientes, pasando de una media de 5,2 al inicio a una de 1,3 al final. Con respecto a la evaluación de la calidad de vida, se observó diferencia únicamente para el dominio de la funcionalidad social en el grupo de emolientes entre la primera y segunda evaluación, sin apreciarse diferencias significantes en el grupo de gabapentina.
Conclusión. Los pacientes experimentaron una mejoría estadísticamente significativa en el prurito con los dos tratamientos; sin embargo, cuando se compararon, no se observó diferencia significativa, por lo que no se puede aseverar, con el tamaño de muestra obtenido, que un tratamiento sea mejor que el otro. En cuanto a la calidad de vida, únicamente en el grupo de emolientes se apreció mejoría en el dominio de funcionalidad social.
Biografía del autor/a
Laura Elena Parra
Médica, residente en Dolor y Cuidado Paliativo, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
Flavio Alberto Restrepo
Médico, residente en Dermatología, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
Luz Marina Gómez
Médica dermatóloga; jefe, Servicio de Dermatología, Universidad Pontificia Bolivariana, Medellín, Colombia
John Jairo Vargas
Médico, especialista en Dolor y Cuidado Paliativo; jefe, Servicio de Dolor y Cuidado Paliativo, Universidad Pontificia Bolivariana, Medellín, Colombia
Referencias bibliográficas
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2. US Renal Data Systems. USRDS 2009 Annual Data Report: Atlas of chronic kidney disease & end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2009.
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4. Stahle-Backdahl M. Uremic pruritus. Semin Dermatol.1995;14:25-9.
5. Mistik S, Utas S, Ferahbas A, Tokgoz B, Unsal G, Sahan H, et al. An epidemiology study of patients with uremic pruritus. J Eur Acad Dermatol Venereol. 2006;20:672-8.
6. Aucella F, Gesuete A. Uremic pruritus: An unresolved challenge. G Ital Nefrol. 2009;26:585-99.
7. Weisshaar E, Dunker N, Gollnick H. Topical capsaicin therapy in humans with hemodialysis-related pruritus. Neurosci Lett. 2003;345:192-4.
8. Makhlough A. Topical capsaicin therapy for uremic pruritus in patients on hemodialysis. Iran J Kidney Dis. 2010;4:137-40.
9. Lysy J, Sistiery-Ittah M, Israelit Y, Shmueli A, StraussLiviatan N, Mindrul V, et al. Topical capsaicin –a novel and effective treatment for idiopathic intractable pruritus ani: A randomized, placebo controlled, crossover study. Gut. 2003;52:1323-6.
10. Pauli-Magnus C, Klumpp S, Alscher DM, Kuhlmann U, Mettang T. Short-term efficacy of tacrolimus ointment in severe uremic pruritus. Perit Dial Int. 2000;20:802-3.
11. Kuypers DR, Claes K, Evenepoel P, Maes B, Vanrenterghem Y. A prospective proof of concept study of the efficacy of tacrolimus ointment on uraemic pruritus in patients on chronic dialysis therapy. Nephrol Dial Transplant. 2004;19:1895-901.
12. Duque MI, Yosipovitch G, Fleischer AB Jr, Willard J, Freedman BI. Lack of efficacy of tacrolimus ointment 0.1% for treatment of hemodialysis-related pruritus: A randomized, double-blind, vehicle-controlled study. J Am Acad Dermatol. 2005;52:519-21.
13. Ivard JR, Henry W. Ultraviolet phototherapy for pruritus. Dermatol Ther. 2005;18:344-54.
14. Hsu MM, Yang CC. Uraemic pruritus responsive to broadband ultraviolet (UV) B therapy does not readily respond to narrowband UVB therapy. Br J Dermatol. 2003;149:888-9.
15. Berneburg M, Cken M, Benedix F. Phototherapy with narrowband Vs. broadband UVB. Acta Derm Venereol. 2005;85:98-108.
16. Pugashetti R, Lim HW, Koo J. Broadband UVB revisited: Is the narrowband UVB fad limiting our therapeutic options? J Dermatolog Treat. 2009; 21:326-30.
17. Manenti L, Vaglio A. Gabapentin for uraemic pruritos. Nephrol Dial Transplant. 2005;20:1278-9.
18. Gunal A, Ozalp G, Yoldas TK, Gunal SY, Kirciman E, Celiker H. Gabapentin therapy for pruritus in haemodialysis patients: A randomized, placebo-controlled, double-blind trial. Nephrol Dial Transplant. 2004;19:3137-9.
19. O’Donoghue M, Harp MDT. Antihistamines and their role as antipruritics. Dermatol Ther. 2005;18:333-40.
20. Francos GC, Kauh YC, Gittlen SD, Schulman ES, Besarab A, Goyal S, et al. Elevated plasma histamine in chronic uremia. Effects of ketotifen on pruritus. Int J Dermatol. 1991;30:884-9.
21. Rosner MH. Cromolyn sodium: A potential therapy for uremic pruritus? Hemodial Int. 2006;10:189-92.
22. Pauli-Magnus C, Mikus G, Alscher DM. Naltrexone does not relieve uremic pruritus: Results of a randomized, doubleblind, placebo-controlled crossover study. J Am Soc Nephrol. 2000;11:514-9.
23. Balaskas EV, Bamihas GI, Karamouzis M, Voyiatzis G, Tourkantonis A. Histamine and serotonin in uremic pruritus: Effect of ondansetron in CAPD-pruritic patients. Nephron. 1998;78:395-402.
24. Wikström B, Gellert R, Ladefoged SD, Danda Y, Akai M, Ide K, et al. Kappa-opioid system in uremic pruritus: Multicenter, randomized, double-blind, placebo-controlled clinical studies. J Am Soc Nephrol. 2005;16:3742-7.
25. Ashmore SD, Jones CH, Newstead CG, Daly MJ, Chrystyn H. Ondansetron therapy for uremic pruritus in hemodialysis patients. Am J Kidney Dis. 2000;35:827-31.2
26. Greaves MW. Itch in systemic disease: Therapeutic options. Dermatol Ther. 2005;18:323-7.
27. Hiroshige K, Kabashima N, Takasugi M, Kuroiwa A. Optimal dialysis improves uremic pruritus. Am J Kidney Dis. 1995;25:413-9.
28. Razeghi E, Eskandari D, Ganji MR, Meysamie AP, Togha M, Khashayar P. Gabapentin and uremic pruritus in hemodialysis patients. Ren Fail. 2009;31:85-90.
29. Vila T, Gommer J, Scates AC. Role of gabapentin in the treatment of uremic pruritus. Ann Pharmacother. 2008;42:1080-4.
30. Boaz M, Shtendik L, Oron M, Portugal-Cohen M, Kohen R, Biro A, et al. A randomized controlled clinical trial comparing the efficacy of dead sea mineral-enriched body lotion versus two types of placebo in the treatment of cutaneous dryness, itching, peeling and tightness in hemodialysis patients (EDIT). Nephron Clin Pract. 2009;113:169-76.
31. Lugo LH, García HI, Gómez C. Confiabilidad del cuestionario de calidad de vida en salud SF-36 en Medellín, Colombia. Rev Fac Nac Salud Pública. 2006;24:37-50
32. Kuypers DR. Skin problems in chronic kidney disease. Nat Clin Pract Nephrol. 2009;5:157-70.
33. Kosmadakis GCh, Papakonstantinou S, Theodoros C, Emmanouel P, Demetrios V, Nicolas Z. Characteristics of uremic pruritus in hemodialysis patients: Data from a single center. Kidney Int. 2008;74:962-3.
34. Narita I, Iguchi S, Omori K, Gejyo F. Uremic pruritus in chronic hemodialysis patients. J Nephrol. 2008;21:161-5.
35. Novak MJ, Sheth H, Bender FH, Fried L, Piraino B. Improvement in Pittsburgh Symptom Score index after initiation of peritoneal dialysis. Adv Perit Dial. 2008;24:46-50.
36. Gómez RA. Renal disease in Colombia. Ren Fail. 2006;28:643-7.
37. Gómez R, editor. Datos colombianos de diálisis y trasplantes para el Registro Latinoamericano de Diálisis [internet]. Bogotá: Asociación Colombiana de Nefrología de Hipertensión Arterial; 2005.: Disponible en: http://www.slanh.org.
38. Sanabria M, Muñoz J, Trillos C, Hernández G, Latorre C, Díaz CS, et al. Dialysis outcomes in Colombia (DOC) study: A comparison of patient survival on peritoneal dialysis Vs. hemodialysis in Colombia. Kidney Int. 2008;108(Suppl.):S165-72.
39. Twycross R, Greaves MW, Handwerker H, Jones EA, Libretto SE, Szepietowski JC, et al. Itch: scratching more than the surface. QJM. 2003;96:7.
40. Yosipovitch G, Greaves MW, Schmelz M. Itch. Lancet. 2003;361:690.
41. Gilchrest BA, Stern RS, Steinman TI, Brown RS, Arndt KA, Anderson WW. Clinical features of pruritus among patients undergoing maintenance hemodialysis. Arch Dermatol. 1982;118:154.
42. Aucella F, Vigilante M, Gesuete A, Maruccio G, Specchio A, Gesualdo L. Uraemic itching: Do polymethylmethacrylate dialysis membranes play a role? Nephrol Dial Transplant. 2007;22:S8-12.
43. Wikstrom B. Itchy skin, a clinical problem for haemodialysis patients. Nephrol Dial Transplant. 2007;22:S37-8.
44. Gonella M, Calibrese G, Mazzotta A, Vagelli G. Uraemic pruritus in RDT patients: Is it still a problem? Nephrol Dial Transplant. 2006;21:3495-505.
45. Murphy M, Carmichael AJ. Renal itch. Clin Exp Dermatol. 2000;25:103-6.
46. Ponticelli C, Becini PL. Uremic pruritus: A review. Nephron.1992;60:1-5.
47. Chen YC, Chiu WT, Wu MS. Therapeutic effect of topical gamma-linolenic acid on refractory uremic pruritus. Am J Kidney Dis. 2006;48:69-76.
48. Szepietowski JC, Szepietowski T, Reich A. Efficacy and tolerance of the cream containing structured physiological lipids with endocannabinoids in the treatment of uremic pruritus: A preliminary study. Acta Dermatovenerol Croat. 2005;13:97-103.
49. Mettang M, Weisshaar E. Pruritus: Control of itch in patients undergoing dialysis. Skin Therapy Lett. 2010;5:1-5.
50. Pereira U, Boulais N, Lebonvallet N, Pennec JP, Dorange G, Misery L. Mechanisms of sensory effects of tacrolimus on the skin. Br J Dermatol. 2010; 163:70-7.
51. Manenti L, Vaglio A, Borgatti PP. Gabapentin as a therapeutic option in uremic pruritus. Kidney Int. 2008;73:512-3.
52. Manenti L, Vaglio A. Gabapentin use in chronic uraemic itch is in line with emerging pathogenetic hypothesis. Nephrol Dial Transplant. 2007;22:3669-70.
53. Morton CA, Lafferty M, Hau C, Henderson I, Jones M, Lowe JG. Pruritus and skin hydration during dialysis. Nephrol Dial Transplant. 1996;11:2031-6.
54. Ostlere LS, Taylor C, Baillod R, Wright S. Relationship between pruritus, transepidermal water loss, and biochemical markers of renal itch in haemodialysis patients. Nephrol Dial Transplant. 1994;9:1302-4.
55. Razeghi E, Eskandari D, Ganji MR, Meysamie AP, Togha M, Khashayar P. Gabapentin and uremic pruritus in hemodialysis patients. Ren Fail. 2009;31:85-90.
56. Durrant-Finn U, Osten B, Mügge C, Nenoff P. Pruritus and dryness of the skin in chronic kidney insufficiency and dialysis patients - a review. Wien Med Wochenschr. 2009;159:317-26.
57. Dyachenko P, Shustak A, Rozenman D. Hemodialysis-related pruritus and associated cutaneous manifestations. Int J Dermatol. 2006;45:664-7.
58. Tercedor J, López-Hernández B, Rodenas JM, Herranz MT, Serrano-Ortega S. Erythropoietin therapy for uremic pruritus. N Engl J Med. 1992;327:734.
59. Balaskas EV, Uldall RP. Erythropoietin treatment does not improve uremic pruritus. Perit Dial Int. 1992;12:330-1.
60. Phan NQ, Bernhard JD, Luger TA, Ständer S. Antipruritic treatment with systemic mu-opioid receptor antagonists: A review. J Am Acad Dermatol. 2010; 63: 680-8
61. Nasrollahi AR, Miladipour A, Ghanei E, Yavari P, Haghverdi F. Montelukast for treatment of refractory pruritus in patients on hemodialysis. Iran J Kidney Dis. 2007;1:73-7.
62. Yosipovitch G, Fleischer A. Itch associated with skin disease: Advances in pathophysiology and emerging therapies. Am J Clin Dermatol. 2003;4:617-22.
63. Greaves MW. Pathogenesis and treatment of pruritus. Curr Allergy Asthma Rep. 2010;10 :236-42.
64. Seckin D, Demircay Z, Akin O. Generalized pruritus treated with narrowband UVB. Int J Dermatol. 2007;46:367-70.
2. US Renal Data Systems. USRDS 2009 Annual Data Report: Atlas of chronic kidney disease & end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2009.
3. Akhyani M, Ganji MR, Samadi N, Khamesan B, Daneshpazhooh M. Pruritus in hemodialysis patients. BMC Dermatol. 2005;24:5-7.
4. Stahle-Backdahl M. Uremic pruritus. Semin Dermatol.1995;14:25-9.
5. Mistik S, Utas S, Ferahbas A, Tokgoz B, Unsal G, Sahan H, et al. An epidemiology study of patients with uremic pruritus. J Eur Acad Dermatol Venereol. 2006;20:672-8.
6. Aucella F, Gesuete A. Uremic pruritus: An unresolved challenge. G Ital Nefrol. 2009;26:585-99.
7. Weisshaar E, Dunker N, Gollnick H. Topical capsaicin therapy in humans with hemodialysis-related pruritus. Neurosci Lett. 2003;345:192-4.
8. Makhlough A. Topical capsaicin therapy for uremic pruritus in patients on hemodialysis. Iran J Kidney Dis. 2010;4:137-40.
9. Lysy J, Sistiery-Ittah M, Israelit Y, Shmueli A, StraussLiviatan N, Mindrul V, et al. Topical capsaicin –a novel and effective treatment for idiopathic intractable pruritus ani: A randomized, placebo controlled, crossover study. Gut. 2003;52:1323-6.
10. Pauli-Magnus C, Klumpp S, Alscher DM, Kuhlmann U, Mettang T. Short-term efficacy of tacrolimus ointment in severe uremic pruritus. Perit Dial Int. 2000;20:802-3.
11. Kuypers DR, Claes K, Evenepoel P, Maes B, Vanrenterghem Y. A prospective proof of concept study of the efficacy of tacrolimus ointment on uraemic pruritus in patients on chronic dialysis therapy. Nephrol Dial Transplant. 2004;19:1895-901.
12. Duque MI, Yosipovitch G, Fleischer AB Jr, Willard J, Freedman BI. Lack of efficacy of tacrolimus ointment 0.1% for treatment of hemodialysis-related pruritus: A randomized, double-blind, vehicle-controlled study. J Am Acad Dermatol. 2005;52:519-21.
13. Ivard JR, Henry W. Ultraviolet phototherapy for pruritus. Dermatol Ther. 2005;18:344-54.
14. Hsu MM, Yang CC. Uraemic pruritus responsive to broadband ultraviolet (UV) B therapy does not readily respond to narrowband UVB therapy. Br J Dermatol. 2003;149:888-9.
15. Berneburg M, Cken M, Benedix F. Phototherapy with narrowband Vs. broadband UVB. Acta Derm Venereol. 2005;85:98-108.
16. Pugashetti R, Lim HW, Koo J. Broadband UVB revisited: Is the narrowband UVB fad limiting our therapeutic options? J Dermatolog Treat. 2009; 21:326-30.
17. Manenti L, Vaglio A. Gabapentin for uraemic pruritos. Nephrol Dial Transplant. 2005;20:1278-9.
18. Gunal A, Ozalp G, Yoldas TK, Gunal SY, Kirciman E, Celiker H. Gabapentin therapy for pruritus in haemodialysis patients: A randomized, placebo-controlled, double-blind trial. Nephrol Dial Transplant. 2004;19:3137-9.
19. O’Donoghue M, Harp MDT. Antihistamines and their role as antipruritics. Dermatol Ther. 2005;18:333-40.
20. Francos GC, Kauh YC, Gittlen SD, Schulman ES, Besarab A, Goyal S, et al. Elevated plasma histamine in chronic uremia. Effects of ketotifen on pruritus. Int J Dermatol. 1991;30:884-9.
21. Rosner MH. Cromolyn sodium: A potential therapy for uremic pruritus? Hemodial Int. 2006;10:189-92.
22. Pauli-Magnus C, Mikus G, Alscher DM. Naltrexone does not relieve uremic pruritus: Results of a randomized, doubleblind, placebo-controlled crossover study. J Am Soc Nephrol. 2000;11:514-9.
23. Balaskas EV, Bamihas GI, Karamouzis M, Voyiatzis G, Tourkantonis A. Histamine and serotonin in uremic pruritus: Effect of ondansetron in CAPD-pruritic patients. Nephron. 1998;78:395-402.
24. Wikström B, Gellert R, Ladefoged SD, Danda Y, Akai M, Ide K, et al. Kappa-opioid system in uremic pruritus: Multicenter, randomized, double-blind, placebo-controlled clinical studies. J Am Soc Nephrol. 2005;16:3742-7.
25. Ashmore SD, Jones CH, Newstead CG, Daly MJ, Chrystyn H. Ondansetron therapy for uremic pruritus in hemodialysis patients. Am J Kidney Dis. 2000;35:827-31.2
26. Greaves MW. Itch in systemic disease: Therapeutic options. Dermatol Ther. 2005;18:323-7.
27. Hiroshige K, Kabashima N, Takasugi M, Kuroiwa A. Optimal dialysis improves uremic pruritus. Am J Kidney Dis. 1995;25:413-9.
28. Razeghi E, Eskandari D, Ganji MR, Meysamie AP, Togha M, Khashayar P. Gabapentin and uremic pruritus in hemodialysis patients. Ren Fail. 2009;31:85-90.
29. Vila T, Gommer J, Scates AC. Role of gabapentin in the treatment of uremic pruritus. Ann Pharmacother. 2008;42:1080-4.
30. Boaz M, Shtendik L, Oron M, Portugal-Cohen M, Kohen R, Biro A, et al. A randomized controlled clinical trial comparing the efficacy of dead sea mineral-enriched body lotion versus two types of placebo in the treatment of cutaneous dryness, itching, peeling and tightness in hemodialysis patients (EDIT). Nephron Clin Pract. 2009;113:169-76.
31. Lugo LH, García HI, Gómez C. Confiabilidad del cuestionario de calidad de vida en salud SF-36 en Medellín, Colombia. Rev Fac Nac Salud Pública. 2006;24:37-50
32. Kuypers DR. Skin problems in chronic kidney disease. Nat Clin Pract Nephrol. 2009;5:157-70.
33. Kosmadakis GCh, Papakonstantinou S, Theodoros C, Emmanouel P, Demetrios V, Nicolas Z. Characteristics of uremic pruritus in hemodialysis patients: Data from a single center. Kidney Int. 2008;74:962-3.
34. Narita I, Iguchi S, Omori K, Gejyo F. Uremic pruritus in chronic hemodialysis patients. J Nephrol. 2008;21:161-5.
35. Novak MJ, Sheth H, Bender FH, Fried L, Piraino B. Improvement in Pittsburgh Symptom Score index after initiation of peritoneal dialysis. Adv Perit Dial. 2008;24:46-50.
36. Gómez RA. Renal disease in Colombia. Ren Fail. 2006;28:643-7.
37. Gómez R, editor. Datos colombianos de diálisis y trasplantes para el Registro Latinoamericano de Diálisis [internet]. Bogotá: Asociación Colombiana de Nefrología de Hipertensión Arterial; 2005.: Disponible en: http://www.slanh.org.
38. Sanabria M, Muñoz J, Trillos C, Hernández G, Latorre C, Díaz CS, et al. Dialysis outcomes in Colombia (DOC) study: A comparison of patient survival on peritoneal dialysis Vs. hemodialysis in Colombia. Kidney Int. 2008;108(Suppl.):S165-72.
39. Twycross R, Greaves MW, Handwerker H, Jones EA, Libretto SE, Szepietowski JC, et al. Itch: scratching more than the surface. QJM. 2003;96:7.
40. Yosipovitch G, Greaves MW, Schmelz M. Itch. Lancet. 2003;361:690.
41. Gilchrest BA, Stern RS, Steinman TI, Brown RS, Arndt KA, Anderson WW. Clinical features of pruritus among patients undergoing maintenance hemodialysis. Arch Dermatol. 1982;118:154.
42. Aucella F, Vigilante M, Gesuete A, Maruccio G, Specchio A, Gesualdo L. Uraemic itching: Do polymethylmethacrylate dialysis membranes play a role? Nephrol Dial Transplant. 2007;22:S8-12.
43. Wikstrom B. Itchy skin, a clinical problem for haemodialysis patients. Nephrol Dial Transplant. 2007;22:S37-8.
44. Gonella M, Calibrese G, Mazzotta A, Vagelli G. Uraemic pruritus in RDT patients: Is it still a problem? Nephrol Dial Transplant. 2006;21:3495-505.
45. Murphy M, Carmichael AJ. Renal itch. Clin Exp Dermatol. 2000;25:103-6.
46. Ponticelli C, Becini PL. Uremic pruritus: A review. Nephron.1992;60:1-5.
47. Chen YC, Chiu WT, Wu MS. Therapeutic effect of topical gamma-linolenic acid on refractory uremic pruritus. Am J Kidney Dis. 2006;48:69-76.
48. Szepietowski JC, Szepietowski T, Reich A. Efficacy and tolerance of the cream containing structured physiological lipids with endocannabinoids in the treatment of uremic pruritus: A preliminary study. Acta Dermatovenerol Croat. 2005;13:97-103.
49. Mettang M, Weisshaar E. Pruritus: Control of itch in patients undergoing dialysis. Skin Therapy Lett. 2010;5:1-5.
50. Pereira U, Boulais N, Lebonvallet N, Pennec JP, Dorange G, Misery L. Mechanisms of sensory effects of tacrolimus on the skin. Br J Dermatol. 2010; 163:70-7.
51. Manenti L, Vaglio A, Borgatti PP. Gabapentin as a therapeutic option in uremic pruritus. Kidney Int. 2008;73:512-3.
52. Manenti L, Vaglio A. Gabapentin use in chronic uraemic itch is in line with emerging pathogenetic hypothesis. Nephrol Dial Transplant. 2007;22:3669-70.
53. Morton CA, Lafferty M, Hau C, Henderson I, Jones M, Lowe JG. Pruritus and skin hydration during dialysis. Nephrol Dial Transplant. 1996;11:2031-6.
54. Ostlere LS, Taylor C, Baillod R, Wright S. Relationship between pruritus, transepidermal water loss, and biochemical markers of renal itch in haemodialysis patients. Nephrol Dial Transplant. 1994;9:1302-4.
55. Razeghi E, Eskandari D, Ganji MR, Meysamie AP, Togha M, Khashayar P. Gabapentin and uremic pruritus in hemodialysis patients. Ren Fail. 2009;31:85-90.
56. Durrant-Finn U, Osten B, Mügge C, Nenoff P. Pruritus and dryness of the skin in chronic kidney insufficiency and dialysis patients - a review. Wien Med Wochenschr. 2009;159:317-26.
57. Dyachenko P, Shustak A, Rozenman D. Hemodialysis-related pruritus and associated cutaneous manifestations. Int J Dermatol. 2006;45:664-7.
58. Tercedor J, López-Hernández B, Rodenas JM, Herranz MT, Serrano-Ortega S. Erythropoietin therapy for uremic pruritus. N Engl J Med. 1992;327:734.
59. Balaskas EV, Uldall RP. Erythropoietin treatment does not improve uremic pruritus. Perit Dial Int. 1992;12:330-1.
60. Phan NQ, Bernhard JD, Luger TA, Ständer S. Antipruritic treatment with systemic mu-opioid receptor antagonists: A review. J Am Acad Dermatol. 2010; 63: 680-8
61. Nasrollahi AR, Miladipour A, Ghanei E, Yavari P, Haghverdi F. Montelukast for treatment of refractory pruritus in patients on hemodialysis. Iran J Kidney Dis. 2007;1:73-7.
62. Yosipovitch G, Fleischer A. Itch associated with skin disease: Advances in pathophysiology and emerging therapies. Am J Clin Dermatol. 2003;4:617-22.
63. Greaves MW. Pathogenesis and treatment of pruritus. Curr Allergy Asthma Rep. 2010;10 :236-42.
64. Seckin D, Demircay Z, Akin O. Generalized pruritus treated with narrowband UVB. Int J Dermatol. 2007;46:367-70.
Cómo citar
1.
Parra LE, Restrepo FA, Gómez LM, Vargas JJ. Manejo eficiente del prurito con emolientes y gabapentina en el paciente urémico y su impacto en la calidad de vida. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 27 de febrero de 2019 [citado 18 de abril de 2024];18(4):196-204. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/335
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2019-02-27
Cómo citar
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Parra LE, Restrepo FA, Gómez LM, Vargas JJ. Manejo eficiente del prurito con emolientes y gabapentina en el paciente urémico y su impacto en la calidad de vida. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 27 de febrero de 2019 [citado 18 de abril de 2024];18(4):196-204. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/335
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