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Title:FactorsInfluencingPruritusinUremicDialysisPatientsAuthors:
1.WangWei-YunMSNRNNursingdepartmentTri-ServiceGeneralHospitalTaiwan./No.325Sec.2ChenggongRd.NeihuDistrictTaipeiCity114TaiwanROC./E-mail:barbarosayun@yahoo.com.tw
2.WangKwua-YunProfessorSchoolofNursingNationalDefenseMedicalCenterTaipeiTaiwan;DoctoralstudentDepartmentofHealthPromotionandHealthEducationNationalTaiwanNormalUniversityTaipeiTaiwan./4FNo.161Min-ChuanE.Rd.Sec.6Taipei114TaiwanROC./E-mail:W6688@mail.ndmctsgh.edu.tw
3.ChuPaulinghttp://www
2.read.com.tw/cgi/ncl3/ncl3requery632c41553d4368616f20204368616f2d6d696e67242c5a615047414b4a69694c485a6a672c3230PhDMDDirectorofDepartmentofNephrologyTri-ServiceGeneralHospitalTaiwan./No.325Sec.2ChenggongRd.NeihuDistrictTaipeiCity114TaiwanROC./E-mail:pchu@seed.net.tw
4.ChangYue-CunePhDProfessorSchoolofMathematicsandGraduateinstituteofMathematicsUniversityofTamkangTaiwan./151Ying-chuanRoadTamsuiTaipeiCounty25137TaiwanR.O.C./ychang@math.tku.edu.twmailto:ychang@math.tku.edu.tw
5.TangYu-YingPhDRNAssistantProfessorSchoolofNursingNationalDefenseMedicalCenterTaipeiTaiwan./4FNo.161Min-ChuanE.Rd.Sec.6Taipei114TaiwanROC./E-mail:ytang@pchome.com.twAddresscorrespondenceto:WangKwua-Yun4FNo.161Min-ChuanE.Rd.Sec.6Taipei114TaiwanROC./Tel:886-2-87923100ext.
18766./Fax:886-2-8792-
3109./E-mail:W6688@mail.ndmctsgh.edu.twRunninghead:UremicpruritusAbstractBackground:Manyresearchstudiesrelatetouremicpruritusbuttheirresultsareinconsistent.TheuremicpruritusrateindialyticpatientsinTaiwanliesroughlybetween55%and90%.HoweverthereareraredataavailabletoshowtheuremicdialyticpruritusrateinTaiwan.Discussingtherelatedfactorsandcreatingapredictionmodelwasthereforeanimportantissue.Methods:Thisstudyusedacross-sectionalstudydesign.110patientswererecruitedfromamedicalcenterinTaiwan.Datawerecollectedbystructuredquestionnaireswhichincludeddemographydiseasedialysisphysiologicparametertraitanxietyandpruriticscale.Datawereanalyzedlogisticregressiontoconstructthepredictionmodelforuremicpruritus.Results:Resultsshowedthatthepruriticincidencerateofuremicdialyticpatientswas
70.9%forpatientswhoreceivedperitonealdialysiswas
72.4%andhemodialysiswas
67.6%.Thesignificantinfluencingfactorsforpruriticsymptomsamonguremicdialyticpatientsweretheoccupationpre-dialysistypesofrenaldiseasechlorideandskinhumidity.Conclusion:Theskinhumiditywasthemostrelevantpruriticsymptom.Thereforewecanteachpatientstouseskinemollientstoincreaseskinhumidityandrelieveitching.Theoptimalgoalistopromotethequalityoflifeofuremicdialyticpatients.Keywords:uremicdialyticpatientspruritusinfluencingfactors.IntroductionDialytictherapyisthemethodusedtomaintainlifeinmosturemicpatients.AccordingtothestatisticalresultsoftheTaiwanSocietyofNephrology1thedialyticpopulationhasincreased7%peryearinTaiwansince1994thatisafterthenationalhealthinsuranceschemewasinstructed.Therehavebeen41675dialyticpeopleinTaiwanuntil
2005.Theprevalenceofdialysisisrankedsecondintheworldwhichseverelythreatenspublichealthfinances.Pruritusisacommondistressingsymptomaffectingmanylong-termdialyticpatients.Theprevalenceofuremicpruritusrangesbetween40and90%.2-4Thesymptomsofdryskinanditchinperitonealdialyticpatientsrangesbetween50and62%.Howeverthesymptomsinhemodialyticpatientsrangesbetween51and86%.5-6Thepatientssufferingfromgeneralizeditchingrangesbetween19and47%.Otherwisethepatientssufferfromlocalizeditchingrangesbetween17and61%.46-8Theitchingisstrongestonbacktheextremitiestheareawherethecatheterisimplantedorthefaceandisassociatedwithdryskinxerosisandsecondaryinfection.39Amongthepatientswithitchingoftheskin36%becameirritable8%becamedepressedandover40%felttheiremotionswereaffectedevencausingsleepdisorders.7810Allofthesedatarevealedthatpatientssuffergreatlyfromuremicpruritus.Manyresearchstudiesrelatetouremicpruritusbuttheirresultsareinconsistent.Sincetherearenodatashowingpredictorsforuremicpruritusindialyticpatientsthepurposeofthisstudywastoidentifytherelatedfactorsofuremicpruritusindialyticpatientsandtoconstructapredictivemodel.MaterialsandMethodsStudydesignThestudywasacross-sectionaldesignandadaptedastructuredquestionnaire.110dialysissubjectswererecruitedfromamedicalcenterinTaipeiTaiwanbetweenDecember2006andMarch2007bypurposivesampling.Outofwhich76subjectswereonperitonealdialysisand34subjectsonhemodialysisthreetimesperweekfourhourspertime.Datawerecollectedduringtheweekinwhichwetookbloodsamplesforcheckingthephysiologicalparametersofthepatients.Theinclusivecriteriawereasfollows:1tobeaged18yearsorolder;2tobealert;3tobeabletowriteorcommunicateinChineseorTaiwanese;4tohavebeenondialytictherapyformorethansixmonths;5nottosufferfrommentaldisorderotherdermatologicdisordersystemicdiseasesuchassevereinfectionhepaticfailurehematologicaldisorderorbiliarytractdisorder.Allpatientssignedawrittenconsentformpriortothestartofthestudy.MeasuresAcomprehensivequestionnairewasusedtocollectdata.Itincludedthebasiccharacteristicsofthepatientsdemographicdiseasedialyticandtraitanxietyphysiologicalparametersandpruriticscore.Intermsofdemographiccharacteristicsagesexoccupationbeforedialysiscurrentoccupationandreligionwerecollected.Diseasecharacteristicsincludedthetypesofrenaldiseaseandresidualrenalfunction.Thepre-dialyticcreatinineclearancerateCCrformulatedbyGault11wasusedtoestimatetheresidualrenalfunctionofpatients.Withregardtodialyticcharacteristicstheseincludedthedialyticmethoddialyticmembraneandadequacyofdialysis.WetooktheformulaofKt/VureabyGotchandSargent12publishedtoestimatetheadequacyofdialysis.Concerninganxietythiswasdescribedasanunpleasantemotionalstateconsistingoffeelingsofuncertainly.13Spielberger14indicatedthatitconsistedofstateanxietyandtraitanxiety.Thetraitanxietyistheindividualizedanxietylevelthatchangeswiththesituation.TheChineselanguageversionoftraitanxietytranslatedandrevisedbyChungandLong15wasusedinthisstudy.Itincluded7itemsofnegativequestionsand13itemsofpositivequestions.Eachitemwasratedona4-pointLikertscalewhereahigherscoreindicatedahigheranxiouspersonality.Cronbach’salphainthepresentstudywas
0.
88.Hematologylaboratorydataandskinmeasurementswereincludedinphysiologicparameters.ThelaboratorydataofcreatininetotalcalciumfreecalciumphosphatecalciumandphosphorusproductsCa*PhematocritparathyroidhormonePTHbloodureanitrogenBUNchloridetriglycerideandmagnesiumwereobtainedfromthemedicalrecord.InrespectofskinmeasurementweadaptedthemultiprobeadaptorMPAmadebyCourage-KhazakaElectronicGmbHinGermanytomeasureskinhumidityandtransepidermalwaterlossTEWL.TheMPAwascorrectedandcheckedregularlybyprofessionalengineerstoensureitsprecision.Pruritusisasubjectiveexperienceofuncomfortableandunpleasantsensationwhichelicitsthedesiretoscratch.16ThedefinitionofuremicpruritusbyDuo17isofitchingboutslastingmorethan10minutesorifnotthetotalnumberofitchingboutshadtobemorethan20timesperhalfaday.ForthisstudywetranslatedandmodifiedbothDuo’s17andHung’s18scalestoevaluateseverityfrequencydistributionandsleepdisturbanceduringdayornightbypatients’recall.Intermsofpruritusseveritythiswasratedona4-pointLikertscale0=nopruritus1=itchingwithoutannoyanceornecessityforscratching2=afewtimesofscratching3=frequentscratching4=scratchingwithoutreliefofitchingortotalrestlessness.Amaximumof8pointscanthusbegivenduringtheday4inthemorning4intheafternoon.Fordistributionamaximumof6pointscanbegivenovertheday3inthemorningand3intheafternoon.Withoutpruritus=0point;itchinginonesinglelocation=1point;scattereditching=2points;generalizeditching=3points.Frequencyofprurituswasjudgedbythenumberofitchingboutsandthedurationofepisodes.Everyfourshortitchingbouts10minoronelongbout≧10minreceived1pointandnopruritusreceived0point.Thusamaximumof5pointscanbegivenduringtheday.Sleepdisturbancewasjudgedbywaking-upperiodsduringthenightforscratching.Wakinguponcebecauseofitchingscored2points.Thusamaximumof14pointscanbegivenduringthenight.Thehighestpossiblescorewas38points.Inourstudyweinvitedfivenephrologydermatologyandnursingexpertstocheckvalidity.ThecontentvalidityindexCVIofthescalewas
1.TheCronbach’salphawas
0.9attheformalstudy.StatisticalanalysisForanalysisofthevariablesthefollowingtestswereused:meanstandarddeviationfrequencypercentagechi-squareteststudent’sttestandmultiplelogisticregressionmodel.TheanalysiswasperformedusingSPSS
13.0forWindows.P<.05wasconsideredstatisticallysignificant.ResultsDistributionofbasiccharacteristicsTheaverageageof110patientswas
53.21±
14.59yearsmean±SD
53.06yearsintheitchgroupand
53.56yearsinthenon-itchgrouprespectively.Theaveragepre-dialyticCCrwas
5.74±
1.62ml/min
5.49ml/minintheitchgroupand
6.34ml/mininthenon-itchgrouprespectively.TheaverageKt/Vureawas
1.87±
0.
531.86intheitchgroupand
1.91inthenon-itchgrouprespectively.Theaveragetraitanxietyinventorywas
43.08±
9.
9243.07intheitchgroupand
40.81inthenon-itchgrouprespectively.OthercharacteristicsareshowninTable
1.DistributionofphysiologicalparametersThephysiologicalparametersofcreatinineCa*PPTHBUNchlorideskinhumidityphosphateandtotalcalciumamongtheitchgroupwerestatisticallysignificantcomparedwiththenon-itchgroup.OtherparametersareshowninTable
2.DistributionofpruritusinuremicdialyticpatientsWeusedthedefinitionbyZuckeretal.8ofanitchingpersoni.e.theappearanceofanitchinaregularpatternduringaperiodofsixmonths.Ofthe110patients
7870.9%hadpruritus.Ofthe76peritonealdialyticpatients
5572.4%hadpruritusandofthe34hemodialyticpatients
2367.6%hadprurirtus.Thepruriticscalerangedfrom0to34mean±SD:
7.75±
7.
17.Forseveritythescoreintheafternoon
1.65washigherthanmorning
1.45andforfrequencythescoreintheafternoon
0.97wassignificantlyhigherthanmorning
0.64t=-
3.04,p
0.
05.Inadditiontheaveragewaking-upforscratchingduringthenightwasonce.ThepredictorsforuremicpruritusUnivariatelogisticregressionanalysiswasperformedtodefinetheeveryvariablesusedforitchingandnon-itching.Thesignificantunivariablesincludedoccupationbeforedialysisreligiondiabeticnephropathylupusnephritisotherrenaldiseasepre-dialyticCCrcreatinineCa*PPTHBUNchlorideandskinhumidity.Thenthemultivariateanalysisoflogisticregressionwasperformed.ThepredictorsincludedoccupationbeforedialysisOdds=
4.1195%C.I.:
1.06-
15.94lupusnephritisOdds=
0.0895%C.I.:
0.01-
0.95otherrenaldiseaseOdds=
0.0795%C.I.:
0.01-
0.70chlorideOdds=
0.8795%C.I.:
0.75-
0.99andskinhumidityOdds=
0.9495%C.I.:
0.88-
0.
99.Theyaccountedfor40%ofthevarianceinuremicdialyticpatientswithpruritusTable
3.DiscussionAftercontrollingtheothervariablesthemultiplelogisticregressionrevealedthesignificantfactorstobeoccupationbeforedialysisthetypesofrenaldiseasechlorideandskinhumidity.Patientswhoworkedbeforedialysisandwithunknownrenaldiseaselowchlorideandlowskinhumidityeasilyincurreduremicpruritus.IntermsofliteraturefromtheMedlinedatabase1987-2006therewereonlytwostudiesMistiketal.19andNaritaetal.20whousedmultiplelogisticregressionfordataanalysis.Moststudiesusedunivariatelogisticregression.Asaresultourdiscussionisdividedintotwopartswithregardtostatisticsused.IntermsofmultiplelogisticregressionthetypesofrenaldiseasetheoddsoftheoccurrenceofpruritusamonglupusnephritiscomparedwiththeunknownrenaldiseasewassignificantlylowerOdds=
0.08;95%CI=
0.01-
0.95andtheoddsofoccurrenceofpruritusamongothersrenaldiseaseswasalsosignificantlylowerOdds=
0.07;95%CI=
0.01-
0.
70.ThesefindingsweredifferentfromtheresultsintheMistiketal.’sstudy.19ThepossibleexplanationforthesefindingsmightbethatwetooktheunknownrenaldiseaseasareferencegroupbutMistiketal.19didnotconsidertheeffectofunknownrenaldisease.Otherwisetheirstudyshowedthatthepatientswithliverdiseaseweremorelikelytohavepruritusbutourstudyhadexcludedpatientswithhepaticfailureorbiliarytractdisorder.Thereasonwasthatweconsideredthatpatientswithliverdiseasemightconfoundtheuremicpruritus.HoweverasthestudybyNaritaetal.20didnotdiscussthetypesofrenaldiseasewecouldnotcompareourresultswiththatstudy.Inadditionwhenskinhumiditydecreasedbyoneunittheoddsofoccurrenceofprurituswerehigher.HoweverthestudiesbyMistiketal.19andNaritaetal.20didnotdiscussskinhumidityintheirregressionmodel.OtherwisethecalciumphosphateBUNandPTHweresignificantpredictorsinthemodelusedbyNaritaetal.20Theresultswerenotconsistentwiththisstudy.Thepossiblereasonmightbethattheauthorsseparatedthevariablesintocategoricalvariablesandthevariablesascontinuousinthisstudy.AccordingtounivariateanalysiswefoundtheskinhumidityinnonpruriticpatientswassignificantlyhigherthaninpruriticpatientsseeTable
2.TheresultdemonstratedthattheskinwasmorehumidinnonpruritucpatientswithsimilarresultsinthestudiesbyRobertsonandMueller3andSzepietowskietal.4Allfindingsshowedthattheuremicpatientsmighthavestratumcorneumexogenousglandandsebaceousfunctionimpairmentduringtheprogressofdiseasewhichinturndecreasedtheskinhumidityandxerosisoccurred.Xerosismightaffecttheterminalnerveontheskinsurfaceordecreasedthethresholdofitchingtoinduceuremicpruritus.3-4Theaboveresultsdemonstratedthatthepatientswithlowskinhumidityorelectrolyteimbalanceincurredprurituseasily.24Inadditionthepre-dialyticCCrCa*PBUNandPTHweresignificantintheunivariatelogisticregressioninthisstudy.Whenthepre-dialyticCCrdecreasedoneunittheoddsofoccurrenceofprurituswassignificantlyhigherOdds=
0.73;95%CI=
0.56-
0.
95.Thereasonmightbethattheworseresidualrenalfunctionwillretainmetabolicmaterialsinthebodytoinducepruritus.SimilarresultswereachievedbyHiroshigeandKuroiwa2whoshowedthattheseverityofpruritusmayreflecttheresidualrenalfunction.InadditiontheCa*PBUNandPTHinpruriticpatientswassignificantlyhigherthannon-pruriticpatients.SimilarresultswerealsopresentinHoetal.9andHiroshigeetal.2ThisshowedthatwhenBUNandPTHareretainedinthebodypatientswithelectrolyteimbalancemighteasilyhavepruritus.249Therewerestillseveralinconsistentresultsintheunivariateanalysiscomparedwiththepreviousfindings.Concerningdermatologicalcharacteristicstherewasnostatisticallysignificantrelationshipbetweensexandpruritusassuggestedinpreviousstudies.821Howevertheχ2testofMistiketal.19andNaritaetal.20showedprurituswasmoresignificantinmalesthaninfemales.Thepossibleexplanationforthesefindingswasthatfemalesusuallyregularlyuseemollientsforskincare.Skinemollientsofaqueousgelcontaininghighwatercontentcouldreduceitchingalmostcompletelyimprovingskindrynessinpatientswithmilduremicpruritus.22-23IntermsofdialyticcharacteristicsthemethodofdialysiswasnotrelatedtouremicpruritusaswasalsofoundbyPonticelliandBencini.24HoweverthehemodialyticmembranewasnotrelatedtouremicprurituswhichisdifferenttopreviousstudiesbySzepietowskietal.4andSchoutenetal.25Apossibleexplanationwasthatallthehemodialyticpatientsinourstudyusednon-complementactivatingmembraneforhigh-fluxandhigh-permeabilitydialysis.InthestudiesbySzepietowskietal.4andSchoutenetal.25howeversomepatientsstillusedthetraditionalcomplementactivatingmembrane.OtherwisetheKt/VureawasnotsignificantlyassociatedwithuremicpruritusinourstudywhichisthesameasresultsinChiuetal.21andZuckeretal.8WealsofoundthattheaverageKt/VureainnonpruriticpatientswashigherthaninpruriticpatientswithsimilarresultsshownbyDyachenkoetal.26ThisindicatedthatthehigherKt/Vureatheloweropportunitytoinducepruritus.HiroshigeandKuroiwa2mentionedthatiftheaverageKt/Vureawashigherthan
1.2-
1.3thepatientcouldhaveeffectivedialysisandwouldnotincurpruritus.AsimilarresultwasshownbyCohenandMasi27whothoughtthatoptimaldialysiswasachievedwhentheKt/Vureawasmorethan
1.
5.Apossibleexplanationwasthatwiththerenalfunctionimpairmentthepruritogenicsubstanceswillberetainedinthebody.TheoptimalKt/Vureacouldimprovethelow-moleculesubstanceexchangeoftoxinsduringthedialysissessionandthereforedecreasetheincidenceofpruritus.HowevertheaverageKt/Vureawashigherthan
1.5inourstudywhichmeantthatpatientscouldhaveadequatedialysis.InthiswaytherewasnosignificantcorrelationbetweenKt/Vureaandpruritus.InsummarytherelationshipbetweenKt/Vureaandpruritusshouldbediscussedinthefuture.Inourstudythetraitanxietywasnotsignificantlyassociatedwithuremicpruritusbuttheaveragescoreoftraitanxietyinpruriticpatientswashigherthaninnonpruriticpatients.Theresultrevealedthatthemoreanxiouspersonalitiesweremoreeasilyattackedbyuremicpruritus;similarresultswerealsofoundinthestudiesbyStangieretalhttp://gateway.ut.ovid.com/gw1/ovidweb.cgiS=IDNJHKJKEEMBNL00DSearch+Link=%22Stangier+U%
22.au..28andAiharaetal.29Thepossibleexplanationmightbethatwhenpatientssufferedfromanxietytheskinlesionsmightbeaggravated.Finallythisstudyfoundaveragewaking-upperiodsduringthenightforscratchingwasonce.ThisresultwassimilartoZuckeretal.8whichconfirmedthatprurituscouldaffectthesleepofthepatients.Inotherwordsscratchingmightaffectthequalityofsleepofthepatients.Wediscussedtherelatedfactorsofuremicpruritusin110dialyticpatients.Aftercontrollingfortheothervariablesthepredictorsweretheoccupationbeforedialysisthetypesofrenaldiseasechlorideandskinhumidity.HowevertheBUNPTHandCa*Pcouldnotbeshownaspredictorsinourregressionmodel.ComparedwiththemodelusedinthestudybyNaritaetal.20wehadinconsistentfindings.Itwillneedmorerelatedresearchtosupportthisfinding.Accordingtoourresultssomeresearchimplicationscanalsobedrawn.Firstlythestandardizeddefinitionofuremicpruritusneededtobeclarifiedforcomparingtheresultsofrelatedresearches.Secondlyalong-termstudytounderstandthemechanismofuremicpruritusandtheinteractionofinfluentialfactorsshouldbeconducted.Manyvariableswerenotsignificantpredictorsinthemultivariateanalysis;furtherstudyshouldthereforebeconductedusingexpandedsamplesinthefuture.Finallytherelationshipbetweenemotionandpruritusneedsfurtherstudy.Intermsofpracticalimplicationsnursesshouldteachpatientstheimportanceofalow-phosphatediettorelievetheoccurrenceofpruritus.Atthesametimethedailyrecordstomemorizethefrequencyandseverityofprurituswillbeneededinthefuture.Simultaneouslynursesshouldeducatepatientstouseskinemollientstoimprovetheirskinhumidity.References
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22.au.IchikawaHhttp://gateway.ut.ovid.com/gw1/ovidweb.cgiS=IDNJHKJKEEMBNL00DSearch+Link=%22Ichikawa+H%
22.au.IkezawaZhttp://gateway.ut.ovid.com/gw1/ovidweb.cgiS=IDNJHKJKEEMBNL00DSearch+Link=%22Ikezawa+Z%
22.au.Acaseofatopicdermatitiswhichshowedcorrelationofpsychologicalstateandlesions–changesofvalueofpsychologicaltestskinlesionandNKcellactivity.Arerugi–JapaneseJAllergol2000;49487-
94.Table
1.ThebasiccharacteristicsofuremicdialyticpatientsN=110variablesN%pruritusN=78non-pruritusN=32N%N%Demographiccharacteristicssexmale
4339.
132411134.4occupationbeforedialysiswithoccupation
6155.
54861.
51340.6currentoccupationwithoccupation
3632.
72734.
6928.1religionwithreligion
7981.
86178.2*
1856.2Diseasecharacteristicstypesofrenaldiseasediabeticnephritis
1513.
6810.3*
721.9CGN
3128.
22126.
91031.3occlusiverenaldisease
32.
722.
613.1lupusnephritis
76.
433.
8412.5hypertensiverenaldisease
1816.
41721.
813.1unknownrenaldisease
2724.
52430.
839.4othersrenaldisease
98.
233.
8618.8Dialyticcharacteristicsdialyticmethodperitonealdialysis
7669.
15570.
52165.6hemodialyticmembranePMMA
1132.
4834.
8327.3PS
1647.
11356.
6327.3Celluloseacetate
411.
814.
3327.3AM-BIO-HX-
9038.
814.
3218.2footnote:*:p
0.05;CGN:chronicglomerularnephritis;PMMA:polytmethylmethacrylate;PS:polysulfone;AM-BIO-HX-90:thebrandedofanon-complementactivatingmembrane.Table
2.ThephysiologicalparametersofuremicdialyticpatientsN=110variablespruritus(n=78)non-pruritus(n=32)meanSDmeanSDcreatinine
12.10*
2.
9610.
353.39Ca*P
57.79*
20.
8847.
7313.97PTH
396.84*
400.
85240.
85192.86BUN
74.68*
20.
2666.
1319.98chloride
95.6*
3.
8898.
135.27skinhumidity
25.79*
9.
8529.
187.11hematocrit
27.
453.
5627.
433.22phosphate
5.96*
1.
985.
111.35magnesium
2.
420.
462.
270.42TEWL
14.
424.
1913.
123.34triglyceride
126.
8557.
53157.
72109.02totalcalcium
9.65*
1.
029.
320.80freecalcium
4.
750.
564.
710.40footnote:*:p
0.05;Ca*P:calciumandphosphorusproduct;PTH:parathyroidhormone;BUN:bloodureanitrogen;TEWL:transepidermalwaterloss;SD:standarddeviationTable
3.MultiplelogisticregressionmodelofpruritusinuremicdialyticpatientsvariableOddsratio295%confidenceintervalDemographiccharacteristicsoccupationbeforedialysisYesVs.no
4.11*
1.06-
15.94religionYesVs.no
2.
120.56-
8.00DiseasecharacteristicstypesofrenaldiseasediabeticnephritisVs.URD
0.
240.03-
1.90CGNVs.URD
0.
300.05-
1.71ORDVs.URD
0.
360.01-
20.01lupusnephritisVs.URD
0.08*
0.01-
0.95HRDVs.URD
6.
270.34-
117.23otherrenaldiseaseVs.URD
0.07*
0.01-
0.70pre-dialyticCCR
0.
850.54-
1.34physiologicalparameterscreatinine
0.
890.67-
1.18Ca*P
1.
020.97-
1.05PTH
1.
011.00-
1.02BUN
1.
020.99-
1.06chloride
0.87*
0.75-
0.99skinhumidity
0.94*
0.88-
0.99footnote*:p
0.05;URD:unknownrenaldisease;CGN:chronicglomerularnephritis;ORD:obstructiverenaldisease;HRD:hypertensiverenaldisease;CCR:creatinineclearancerate;Ca*P:calciumandphosphorusproduct;PTH:parathyroidhormone;BUN:bloodureanitrogen摘要台灣尿毒透析病人搔癢比率介於55-90%,而針對透析病人搔癢之研究結果多不一致,故本文欲瞭解影響尿毒透析病人搔癢症之相關因素及其預測模式本研究採橫斷式調查研究設計,北市某醫學中心透析室為研究場所,利用結構式問卷進行資料收集問卷內容包含人口學特性、疾病特性、透析因素、生理參數、特質焦慮與皮膚搔癢量表等,以SPSS套裝軟體
15.0版進行資料處理,採用邏輯式迴歸建構搔癢症的預測模式於110份問卷結果發現尿毒透析病人搔癢發生機率為
70.9%,其中腹膜透析者佔
72.4%,行血液透析者發生搔癢的佔
67.6%而尿毒透析病人目前是否有搔癢之最有力的相關因素包含透析前職業、腎臟疾病的種類、血氯及皮膚潮濕度根據此研究結果得知,尿毒透析病人的皮膚潮濕度與目前是否搔癢有關,因此,應衛教透析病人使用皮膚潤滑劑,以增加皮膚的潮濕度,減少搔癢症狀的發生,以增進其生活品質為最終目的關鍵字尿毒透析病人、搔癢症、影響因子18。