Evaluation of Dermatological Findings in Hemodialysis Patients

Abstract

Aim: Chronic kidney disease is an increasing global public health concern. Hemodialysis is the most commonly utilized replacement therapy for end-stage renal disease. Common dermatological complications in hemodialysis patients, such as pruritus, xerosis, and nail or mucosal changes, significantly impair quality of life. This study aims to assess the prevalence and characteristics of these dermatological findings in hemodialysis patients. Materials and Methods: This cross-sectional study was carried out between September 20 and November 20, 2020, in a city in Eastern Türkiye. A total of 132 hemodialysis patients underwent a detailed dermatological examination. All pathological dermatological findings were documented, and their associations with comorbidities, duration of hemodialysis, frequency of hemodialysis, and age were evaluated. Results: At least one dermatological finding was detected in all cases among the 132 patients included in the study (mean age: 58.06 years; 48.5% female). Pruritus was observed in 36.4% of the patients, while xerosis was noted in 50%. Nail changes were recorded in 60.6% of the patients. Among oral mucosal findings, the most common were xerostomia (28%) and oral candidiasis (18.2%). Pigmentation disorders were identified in 39.4% of the patients, whereas 38.6% exhibited local complications at the fistula site. Advanced age was significantly associated with a higher prevalence of pruritus (p=0.003), xerosis (p=0.039), and oral candidiasis (p=0.008). Conclusion: Dermatological findings are common and diverse in hemodialysis patients. Pruritus, xerosis, and oral candidiasis significantly increase with aging, highlighting the need for targeted dermatological care. These findings underscore the importance of regular dermatological evaluations to improve patient outcomes and quality of life.

Keywords

• skin
• dermatologic manifestation
• hemodialysis
• mucocutaneous

References

1. 1. Barsoum RS. End-stage renal disease in North Africa. Kid Int Suppl. 2003;83:111-4.
2. 2. Aziz H, Hussein A, Zakari M. Myeloperoxidase and coenzyme Q10 modulated in the chronic kidney disease patients. Georgian Med News. 2023;(344):124–128.
3. 3. Burns RB, Waikar SS, Wachterman MW, Kanjee Z. Management Options for an Older Adult With Advanced Chronic Kidney Disease and Dementia: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med. 2020;173(3):217–225.
4. 4. Bi LM, Chen YL, Chen YF, Zhu DY, Lu S, Feng DX. [Strategies of interventing complications in hemodialysis with classical prescriptions from clinical cases]. Zhongguo Zhong Yao Za Zhi. 2018;43(12):2470–2473.
5. 5. Tajalli F, Mirahmadi SM, Mozafarpoor S, Goodarzi A, Nasiri Partovi M, Lakestani D. Mucocutaneous manifestations of patients with chronic kidney disease under hemodialysis: A cross-sectional study of 49 patients. Dermatol Ther. 2021;34(4):e15015.
6. 6. Altun E. Hemodiyaliz Tedavisine Devam Eden Hastalarda Cilt Lezyonlarının Sıklığı ve İlişkili Faktörler: Tek Merkez Deneyimi. KSU Medical Journal, 2022, 17. 2:134–139.
7. 7. Dyachenko P, Shustak A, Rozenman D. Hemodialysis-related pruritus and associated cutaneous manifestations. Int J Dermatol. 2006;45(6):664–7.
8. 8. Dahbi N, Hocar O, Akhdari N, Amal S, Bassit N, Fadili W, et al. Manifestations cutanées chez les hémodialysés chroniques [Cutaneous manifestations in hemodialysis patients]. Nephrol T her. 2014;10(2):101–5. French.

9. 9. Karthikeyan K. A clinical study of cutaneous and mucosal manifestations in patients with chronic renal failure on hemodialysis. Int J Res Dermatol. 2017;3:120.
10. 10. Peres LA, Passarini SR, Branco MF, Kruger LA. Skin lesions in chronic renal dialysis. J Bras Nefrol. 2014;36(1):42–47.
11. 11. Tajbakhsh R, Dehghan M, Azarhoosh R, Haghighi AN, Sadani S, Zadeh SS, et al. Mucocutaneous manifestations and nail changes in patients with end-stage renal disease on hemodialysis. Saudi J Kidney Dis Transpl. 2013;24(1):36–40.
12. 12. Adégbidi H, Akpadjan F, Houngbo O, Vigan J, Dégboé B, Agbessi N, et al. Epidemiological and Clinical Profile of Dermatoses Observed in Chronic Hemodialysis Patients at the National Teaching Hospital (NTH-HKM) of Cotonou, Benin. Dermatol Res Pract. 2020;2020:918630
13. 13. Park TH, Park CH, Ha SK, Lee SH, Song KS, Lee HY, et al. Dry skin (xerosis) in patients undergoing maintenance hemodialysis: the role of decreased sweating of the eccrine sweat gland. Nephrol Dial Transplant. 1995;10:2269–73.
14. 14. Specchio F, Carboni I, Chimenti S, Tamburi F, Nistico’ S. Cutaneous manifestations in patients with chronic renal failure on hemodialysis. Int J Immunopathol Pharmacol. 2014 JanMar;27(1):1–4.
15. 15. Akhyani M, Ganji MR, Samadi N, Khamesan B, Daneshpazhooh M. Pruritus in hemodialysis patients. BMC Dermatol. 2005;5:7. Kafkas J Med Sci 2025; 15(2):178–183183
16. 16. Dwiyana RF, Tsaqilah L, Sukesi L, Setiawan, Avriyanti E, Suhada KU, et al. Characteristics of Xerosis, Pruritus, and Pallor in Stage 5 Chronic Kidney Disease Patients Undergoing Hemodialysis at Dr. Hasan Sadikin General Hospital, Bandung. Clin Cosmet Investig Dermatol. 2023;16:2613–2621.
17. 17. Anees M, Butt G, Gull S, Nazeer A, Hussain I, Ibrahim M. Factors affecting dermatological manifestations in patients with end stage renal disease. J Coll Physicians Surg Pak. 2018;28(2):98–102.
18. 18. Headley CM, Wall B. ESRD-associated cutaneous manifestations in a hemodialysis population. Nephrol Nurs J. 2002;29(6):525–7, 531.
19. 19. Nassar GM, Ayus JC. Infectious complications of the hemodialysis access. Kidney Int. 2001;60(1):1–13.
20. 20. Oyetola EO, Owotade FJ, Agbelusi GA, Fatusi OA, Sanusi AA. Oral f indings in chronic kidney disease: implications for management in developing countries. BMC Oral Health 2015. p. 15:24.
21. 21. Ras AA, Kheir El Din NH, Talaat AM, Hussein RR, Khalil E. Mucocutaneous Changes in End-Stage Renal Disease Under Regular Hemodialysis - A Cross-Sectional Study. Indian J Dent Res. 2023 Apr-Jun;34(2):130–135.
22. 22. Eftekhari H, Haghdar Saheli Y, Ashoobi MT, Mahjoob M, Kazemnezhad Leyli E, Bagheri Toolaroud P. The prevalence of onychomycosis in patients with chronic renal failure undergoing dialysis: A cross-sectional study. Heliyon. 2024;10(4):e25737.
23. 23. Mourad B, Hegab D, Okasha K, Rizk S. Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt. Clin Cosmet Investig Dermatol. 2014;7:313–9.
24. 24. Fernandez-Flores A, Gatica-Torres M, Ruelas-Villavicencio AL, Saeb-Lima M. Morphological clues in the diagnosis of sclerodermiform dermatitis. Am J Dermatopathol. 2014;36(6):449–64.
25. 25. Fernandes KA, Lima LA, Guedes JC, Lima RB, D’Acri AM, Martins CJ. Acquired perforating dermatosis in a patient with chronic renal failure. An Bras Dermatol. 2016 Sep-Oct;91(5 suppl 1):10–13.
26. 26. Vukusich A, Fierro A, Morales J, Fantuzzi A, Vukusich C, Mañalich J, et al. Epidemiología de la hipertensión en hemodiálisis crónica [Epidemiology of hypertension in chronic hemodialysis]. Rev Med Chil. 2002;130(6):610–5.