The role of blood purification therapies in the treatment of chronic kidney disease–associated pruritus: a systematic review
ABSTRACT Chronic kidney disease–associated pruritus (CKD-aP) is a common complication in dialysis patients which is not fully addressed by pharmacological and dialytic therapy. The objective was to review the literature on the effects of extracorporeal blood purification modalities on CKD-aP. The po...
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| Veröffentlicht in: | Clinical kidney journal 2024-09, Vol.17 (9), p.sfae266 |
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| creator | Marcello, Matteo Marturano, Davide Ronco, Claudio Zanella, Monica |
| description | ABSTRACT
Chronic kidney disease–associated pruritus (CKD-aP) is a common complication in dialysis patients which is not fully addressed by pharmacological and dialytic therapy. The objective was to review the literature on the effects of extracorporeal blood purification modalities on CKD-aP. The population comprised patients aged ≥18 years on chronic dialysis. PubMed, Embase, and Medline were systematically searched until February 2024 for clinical studies comparing the effect of different dialysis modalities on pruritus intensity. Two reviewers extracted data independently. Risk of bias for randomized controlled trials (RCTs) was assessed using the Cochrane tool. Any extracorporeal blood purification therapy for the treatment of CKD-aP was included. Outcome was quantitative change in pruritus intensity on a validated itching scale. This review included eight RCTs examining five different dialysis modalities, three observational studies examining three dialysis modalities, and six prospective clinical trials assessing four dialysis modalities. These treatments included peritoneal dialysis, low-flux and high-flux dialysis, hemodiafiltration, expanded hemodialysis, hemadsorption, hemodiafiltration with endogenous reinfusion and dialysis with polymethylmethacrylate membrane. Risk of bias was high in most studies. The largest body of evidence was found for the efficacy of hemadsorption. Limitations of evidence included heterogeneity in diagnostic tools and treatment, risk of selection bias, small sample sizes and short follow-up durations that made it challenging to perform a robust systematic review and meta-analysis. Despite the high prevalence of pruritus among dialysis patients, current evidence for efficacy of standard dialytic treatment is weak. The only technique that appears to be effective is hemoadsorption alone or coupled with hemodialysis. More high-quality studies are needed to confirm the long-term benefits. |
| doi_str_mv | 10.1093/ckj/sfae266 |
| format | Article |
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Chronic kidney disease–associated pruritus (CKD-aP) is a common complication in dialysis patients which is not fully addressed by pharmacological and dialytic therapy. The objective was to review the literature on the effects of extracorporeal blood purification modalities on CKD-aP. The population comprised patients aged ≥18 years on chronic dialysis. PubMed, Embase, and Medline were systematically searched until February 2024 for clinical studies comparing the effect of different dialysis modalities on pruritus intensity. Two reviewers extracted data independently. Risk of bias for randomized controlled trials (RCTs) was assessed using the Cochrane tool. Any extracorporeal blood purification therapy for the treatment of CKD-aP was included. Outcome was quantitative change in pruritus intensity on a validated itching scale. This review included eight RCTs examining five different dialysis modalities, three observational studies examining three dialysis modalities, and six prospective clinical trials assessing four dialysis modalities. These treatments included peritoneal dialysis, low-flux and high-flux dialysis, hemodiafiltration, expanded hemodialysis, hemadsorption, hemodiafiltration with endogenous reinfusion and dialysis with polymethylmethacrylate membrane. Risk of bias was high in most studies. The largest body of evidence was found for the efficacy of hemadsorption. Limitations of evidence included heterogeneity in diagnostic tools and treatment, risk of selection bias, small sample sizes and short follow-up durations that made it challenging to perform a robust systematic review and meta-analysis. Despite the high prevalence of pruritus among dialysis patients, current evidence for efficacy of standard dialytic treatment is weak. The only technique that appears to be effective is hemoadsorption alone or coupled with hemodialysis. More high-quality studies are needed to confirm the long-term benefits.</description><identifier>ISSN: 2048-8505</identifier><identifier>EISSN: 2048-8513</identifier><identifier>DOI: 10.1093/ckj/sfae266</identifier><identifier>PMID: 39319306</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Analysis ; Care and treatment ; Chronic kidney failure ; CKJ Review ; Medical research ; Medicine, Experimental ; Polymethylmethacrylate ; Pruritus</subject><ispartof>Clinical kidney journal, 2024-09, Vol.17 (9), p.sfae266</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the ERA. 2024</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.</rights><rights>COPYRIGHT 2024 Oxford University Press</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c368t-c7abd8cf55c403528df71c31f20e46010c857e0e2a39c982b43c445eec36bae73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420667/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420667/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,1598,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39319306$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marcello, Matteo</creatorcontrib><creatorcontrib>Marturano, Davide</creatorcontrib><creatorcontrib>Ronco, Claudio</creatorcontrib><creatorcontrib>Zanella, Monica</creatorcontrib><title>The role of blood purification therapies in the treatment of chronic kidney disease–associated pruritus: a systematic review</title><title>Clinical kidney journal</title><addtitle>Clin Kidney J</addtitle><description>ABSTRACT
Chronic kidney disease–associated pruritus (CKD-aP) is a common complication in dialysis patients which is not fully addressed by pharmacological and dialytic therapy. The objective was to review the literature on the effects of extracorporeal blood purification modalities on CKD-aP. The population comprised patients aged ≥18 years on chronic dialysis. PubMed, Embase, and Medline were systematically searched until February 2024 for clinical studies comparing the effect of different dialysis modalities on pruritus intensity. Two reviewers extracted data independently. Risk of bias for randomized controlled trials (RCTs) was assessed using the Cochrane tool. Any extracorporeal blood purification therapy for the treatment of CKD-aP was included. Outcome was quantitative change in pruritus intensity on a validated itching scale. This review included eight RCTs examining five different dialysis modalities, three observational studies examining three dialysis modalities, and six prospective clinical trials assessing four dialysis modalities. These treatments included peritoneal dialysis, low-flux and high-flux dialysis, hemodiafiltration, expanded hemodialysis, hemadsorption, hemodiafiltration with endogenous reinfusion and dialysis with polymethylmethacrylate membrane. Risk of bias was high in most studies. The largest body of evidence was found for the efficacy of hemadsorption. Limitations of evidence included heterogeneity in diagnostic tools and treatment, risk of selection bias, small sample sizes and short follow-up durations that made it challenging to perform a robust systematic review and meta-analysis. Despite the high prevalence of pruritus among dialysis patients, current evidence for efficacy of standard dialytic treatment is weak. The only technique that appears to be effective is hemoadsorption alone or coupled with hemodialysis. More high-quality studies are needed to confirm the long-term benefits.</description><subject>Analysis</subject><subject>Care and treatment</subject><subject>Chronic kidney failure</subject><subject>CKJ Review</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Polymethylmethacrylate</subject><subject>Pruritus</subject><issn>2048-8505</issn><issn>2048-8513</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><recordid>eNp9kl1rFDEUhoMottReeS8BQQTZNpkk8-GNlKK2UPCmXofMmZNu2pnJmGQqeyP-B_9hf0mz3e1iQUwgX-d5X044h5DXnB1x1ohjuLk-jtZgUZbPyH7BZL2oFRfPd2em9shhjNcsjxxhUr0ke6IRvBGs3Ce_LpdIg--Rekvb3vuOTnNw1oFJzo80LTGYyWGk7uFCU0CTBhzTWgDL4EcH9MZ1I65o5yKaiHe__5gYPTiTMNuF7Jfm-JEaGlcx4ZCdgQa8dfjzFXlhTR_xcLsfkO9fPl-eni0uvn09Pz25WIAo67SAyrRdDVYpkEyoou5sxUFwWzCUJeMMalUhw8KIBpq6aKUAKRVilrcGK3FAPm18p7kdsIOcfzC9noIbTFhpb5x-GhndUl_5W825LFhZrh3ebx2C_zFjTHpwEbDvzYh-jlrkcsi8yCajbzfolelRu9H6bAlrXJ_UXJVN01QiU0f_oPLscHDgR7Quvz8RfNgIIPgYA9pd-pzpdTPo3Ax62wyZfvP3j3fsY-kz8G4D-Hn6r9M9lGvBKA</recordid><startdate>202409</startdate><enddate>202409</enddate><creator>Marcello, Matteo</creator><creator>Marturano, Davide</creator><creator>Ronco, Claudio</creator><creator>Zanella, Monica</creator><general>Oxford University Press</general><scope>TOX</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>202409</creationdate><title>The role of blood purification therapies in the treatment of chronic kidney disease–associated pruritus: a systematic review</title><author>Marcello, Matteo ; Marturano, Davide ; Ronco, Claudio ; Zanella, Monica</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-c7abd8cf55c403528df71c31f20e46010c857e0e2a39c982b43c445eec36bae73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Analysis</topic><topic>Care and treatment</topic><topic>Chronic kidney failure</topic><topic>CKJ Review</topic><topic>Medical research</topic><topic>Medicine, Experimental</topic><topic>Polymethylmethacrylate</topic><topic>Pruritus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marcello, Matteo</creatorcontrib><creatorcontrib>Marturano, Davide</creatorcontrib><creatorcontrib>Ronco, Claudio</creatorcontrib><creatorcontrib>Zanella, Monica</creatorcontrib><collection>Oxford Open</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical kidney journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marcello, Matteo</au><au>Marturano, Davide</au><au>Ronco, Claudio</au><au>Zanella, Monica</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The role of blood purification therapies in the treatment of chronic kidney disease–associated pruritus: a systematic review</atitle><jtitle>Clinical kidney journal</jtitle><addtitle>Clin Kidney J</addtitle><date>2024-09</date><risdate>2024</risdate><volume>17</volume><issue>9</issue><spage>sfae266</spage><pages>sfae266-</pages><issn>2048-8505</issn><eissn>2048-8513</eissn><abstract>ABSTRACT
Chronic kidney disease–associated pruritus (CKD-aP) is a common complication in dialysis patients which is not fully addressed by pharmacological and dialytic therapy. The objective was to review the literature on the effects of extracorporeal blood purification modalities on CKD-aP. The population comprised patients aged ≥18 years on chronic dialysis. PubMed, Embase, and Medline were systematically searched until February 2024 for clinical studies comparing the effect of different dialysis modalities on pruritus intensity. Two reviewers extracted data independently. Risk of bias for randomized controlled trials (RCTs) was assessed using the Cochrane tool. Any extracorporeal blood purification therapy for the treatment of CKD-aP was included. Outcome was quantitative change in pruritus intensity on a validated itching scale. This review included eight RCTs examining five different dialysis modalities, three observational studies examining three dialysis modalities, and six prospective clinical trials assessing four dialysis modalities. These treatments included peritoneal dialysis, low-flux and high-flux dialysis, hemodiafiltration, expanded hemodialysis, hemadsorption, hemodiafiltration with endogenous reinfusion and dialysis with polymethylmethacrylate membrane. Risk of bias was high in most studies. The largest body of evidence was found for the efficacy of hemadsorption. Limitations of evidence included heterogeneity in diagnostic tools and treatment, risk of selection bias, small sample sizes and short follow-up durations that made it challenging to perform a robust systematic review and meta-analysis. Despite the high prevalence of pruritus among dialysis patients, current evidence for efficacy of standard dialytic treatment is weak. The only technique that appears to be effective is hemoadsorption alone or coupled with hemodialysis. More high-quality studies are needed to confirm the long-term benefits.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>39319306</pmid><doi>10.1093/ckj/sfae266</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Analysis Care and treatment Chronic kidney failure CKJ Review Medical research Medicine, Experimental Polymethylmethacrylate Pruritus |
| title | The role of blood purification therapies in the treatment of chronic kidney disease–associated pruritus: a systematic review |
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