DERMATOLOGICAL MANIFESTATIONS IN CHRONIC HEMODIALYSIS PATIENTS

Abstract

Cutaneous manifestations are very common in CKD patients and impact their quality of life, they can induce serious discomfort, anxiety, depression and sleeping disorders and have an overall negative effect on mental and physical health. The present study had an objective of evaluation of the prevalence of various skin and mucocutaneous manifestations in chronic hemodialysis patients and studied their correlation to clinical and biochemical disturbance in these patients. The study included about 150 patients on conventional regular HD collected from hemodialysis units, Ain Shams University Hospital in Cairo, Egypt Among them, there were 76 (50.7%) male and 74 (49.3%) female .The mean age of these patients was 49.47± 12.95 yrs with range (21-77) year, The mean duration of dialysis was 8.64± 5.72. Patients with diabetes mellitus were 17 (11.3%) and hypertension were 52 (34.7%). All patients were thoroughly examined for skin changes, hair, nails and mucous membrane by dermatologist and laboratory tests were assessed. Pruritus was the commonest and most bothersome symptom observed in our study, affecting 117 (78%) patients, followed by Xerosis ,seen in 80 (53.3%) patients predominantly involved extensor aspect of legs, thighs, and forearms, 2ry ichthyosis in 15 (10%) of the patients ,involved large areas of the body. The prevalence of hyperpigmentation in this study was 43 (28.7%) and presented as localized or diffuse brownish-black pigmentations on sun-exposed areas. Ecchymosis was detected in 4 (2.7%) of the studied patients. It was observed around the arteriovenous fistula. Other dermatoses like calcinosis cutis 1 (.7%), Jaundice 24 (16%), eczema 10 (10%), Tania versicolour 1 (.7%), cellulitis 1 (.7%), pitting 4 (2.7%), seborric keratosis 3 (2%), urimic frost 3 (2%), xanthelasma 2 (1.3%) were seen in patients in our study. Nail changes observed in our study were half and half nail 10 (6.7%), Onychomycosis was observed in 5 (3.3%), followed by Onycholysis 3 (2%), leukonyckia 2 (1.3%) of the included patients. Hair disorders such as hair loss were observed in 28 (18.7%) and of the patients. The most common oral mucosal manifestation in this study was aphthus stomatitis 5 (3.3%) and herpes simplex 5 (3.3%) of the patients in this study, Lesions may vary in size, number, and involved site. They usually resolve spontaneously and may relapse. This study showed the patients with xerosis had significant high dry weight and ultrafiltration rate per session in comparison to patients without xerosis (P<0.05). According to patient's medications, patients with xerosis had significant high dose of iron in comparison to patients without xerosis there (P<0.05) . According to laboratory results, patients without Xerosis had high significant Calcium, PTH, Iron and creatinine (P <0.05) and highly significant ferritin level (P value <0.01). No significant difference regarding phosphorous, albumin, TIBC, TSAT, URR or CRP titer (P >0.05) Correlation between xerosis and patient's characteristics revealed that no significant correlation between xerosis and sex, cause of ESRD vascular access or HCV among studied patients. Correlation between pruritis and patient's characteristics revealed that no significant correlation between pruritis and sex, cause of ESRD vascular access or HCV among studied patients. By comparison between patients with pruritus and patients without regarding patient's characteristics there is no significant difference as regards age, BMI, duration of dialysis, MAP, intradialytic weight gain and dry weight. Patients with pruritus had significant high dose of calcium and hepain in comparison to patients without pruritis (P <0.05).