Araştırma Makalesi
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Skin Changes, Frequencies and Associated Factors in Maintanence Hemodialysis Patients: Single Center Experience

Yıl 2022, Cilt: 17 Sayı: 2, 134 - 139, 15.07.2022
https://doi.org/10.17517/ksutfd.1096741

Öz

Objective: In this study, we aimed to evaluated to the prevalance of skin lesions among patients with undergoing hemodialysis and to determine their relations with dialysis adequacy, time of hemodialysis and co-morbid diseases.
Material and Methods: Two hundred forty four hemodialysis patients were included in the study. Patients was examined by a volunteer dermatologist during their monthly pyhsical examinations. All other data were recorded retrospectively from hospital record system.
Results: The patients were 102 (42%) women and 142 (58%) men with a mean age of 58.0±18.2 years. The median duration of hemodialysis was 4.2 years. The most common skin finding was xerosis, which was present in 60.6% of the patients. Other common skin findings were pruritis (53%), hair reduction
(49.5%), hair changes (47.9%), nail changes (42.5%), eczema (20.9%), and hyperpigmentation (8.6%), in order of frequency. Xerosis was more commonly found in diabetic patients than non-diabetic. (p<0.001). A significant relationship was seen between dialysis adequacy (Kt/V) and pruritis and xerosis (p=0.01).
There was no significant correlations between skin lesions and Calcium (Ca), phospour (P), CaXP, parathormon (PTH) ferritin or albumin. The rate of onychomycosis included in the nail changes category was found to be statistically significantly higher in the diabetic patient group than in the non-diabetic patient group (p=0.01). Premalignant and malign skin lesions were detected in 7 patients in the diabetic group and in 2 patients in the non-diabetic group.
Conclusion: Skin lesions are common in CRF patients, and although the prevalence of skin lesions, it has been showed that in many studies, as in our study, that xerosis and pruritis are the most common in both predialysis and dialysis patients. A detailed dermatological examination may play an important role in
the diagnosis of skin lesions earlier and this increased of quality of life in patients.

Kaynakça

  • Abdelbaqi SM, Shalhub S, Morgan MB. A current review of the cutaneous manifestations of renal disease. J CutanPathol. 2003;30:527-538.
  • Leena JA, Noman MU, Islam MMSU, Ahmed AS, Ahmed DS, Rahma MM. Cutaneous Manifestations of Chronic Kidney Disease. Farid pur Med Coll J. 2012;7:33-36.
  • Nunley JR. Dermatologic manifestations of renal disease. E Med J 2002;550.
  • Lupi O, Rezende L, Zangrando M, Sessim M, Silveira CB, Sepulcri MA et al. Cutaneous manifestations in end-stage renal disease. An Bras Dermatol. 2011;86:319-326.
  • Khan R, Quaiser S, Haque SF, Sachdeva S. Cutaneous Manifestations in Patients of Chronic Kidney Disease. Int J Cur Bio Med Sci. 2011;1:113-115.
  • Nordal EJ, Os I. Uremic pruritus pathogenesis and treatment. Tidsskr Nor Laegeforen 2007;127:1201-1203.
  • Mourad B, Hegab D, Okasha K, Rizk SI. Prospectivestudy on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals. Egypt Clin Cosmet Investig Dermatol 2014;7:313–319.
  • Gammal C, Pagnoni A, Kligman AM, Gammal S. A model to assess the efficacy of moisturizers–the quantification of soap induced xerosis by image analysis of adhesive-coateddiscs (D-squames). Clin Exp Dermatol 1996;21:338-343.
  • Yaghubi R, Niloufar S, Latifee SM. Cutaneous manifestations of end stage renal disease under hemodialysis. Iran J Dermatol. 2002;5:29-34.
  • Deshmukh SP, Sharma YK, Dash K, Chaudhari NC, Deo KS. Clinico epidemiological study of skin manifestations in patients of chronic renal failure on hemodialysis. Indian Dermatol Online J. 2013;4:18-21.
  • Zucker I, Yosipovitch G, David M, Gafter U, Boner G. Prevalence and characterization of uremic pruritus in patient undergoing hemodialysis: uremic pruritus is stil a major problem for patients with end-stage renal disease. J AmAcadDermatol 2003;49:842- 846.
  • Akhyani M, Ganji M, Samadi N, Khamesan B, Daneshpazhooh M. Pruritus in hemodialysis patients. BMC Dermatology 2005;5:7.
  • Sanad EM, Sorour NE, Saudi WM, Elmasry AM. Prevalence of cutaneous manifestations in chronic renal failure patients on regular hemodialysis: a hospital based study. Egyptian J Dermatol Venereol. 2014;34:27-35.
  • Rashpa RS, Mahajan VK, Kumar P, Mehta KS, Chauhan PS, Rawat R et al. Mucocutaneous manifestations in patients with chronic kidney disease: A cross-sectional study. Indian Dermatol Online J. 2018;9:20-26.
  • Aktas SB, Atış G, Demirci GT, Çolak H. Tip II Diyabetli hastalarda Gözlenen Cilt Bulguları: Tepecik Eğit Hast Derg 2014;24(1):37-42
  • Hattem SV, Bootsma AH, Thio HB. Skin manifestations of diabetes. Cleveland ClinicJournal of medicine 2008;75(11): 772-787.
  • Landing BH, Wells TR, Williamson ML. Anatomy of eccrinesweat glands in children with chronic renal insufficiency and other fatal chronic diseases. Am J Pathol 1970;54:15-21.
  • Morton CA, Lafferty M, Hau C, Henderson I, Jones M, Lowe JG. Pruritus and skin hydration during dialysis. Nephrol Dial Transplant 1996;11:2031-2036.
  • Falodun O, Ogunbiyi A, Salako B, George A K. Skin changes in patients with chronic renal failure. Saudi J Kidney Dis Transplant 2011;22:268-272.
  • Adelakun TA, Akinsola A. Hypertension induced chronic renalfailure: Clinical features, management and prognosis. West Afr J Med 1998;17:104-108.
  • Dyachenko P, Monselise A, Shustak A, Ziv M, Rozenman D. Nail disorders in patients with chronic renal failure and undergoing haemodilysis treatment. J Eur Acad Dermatol Venereol 2007;21:340-344
  • Jamal A, Subramanian PT, Hussain KS. Nail changes in end-stage renal failure patients on hemodilysis. Saudi J Kidney Dis Transpl 2000;11:44-47.
  • Cevher ŞK, Yenigün EÇ, Yetkin H, Aypak C, Dede F. Prediyaliz Kronik Böbrek Hastalığına Eşlik Eden Cilt Lezyonları. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi: 2018: 27:157–161.
  • Udayakumar P, Balasubramainan S, Ramalingam KS, Lakshi MC, Srinivas CR, Mathew AC. Cutaneous manifestatious in patients with chronic renal failure on hemodialysis. Indian J Dermatol Venereal Leprol 2006;72:119-125.
  • Seethapathy H, Brandenburg VM, Sinha S, Azhary RA, Nigwekar SU. Review: update on themanagement of calciphylaxis. QJM. 2019;112(1):29-34.
  • Mathur M, Jones JR, Weinreb JC. Gadolinium Deposition and Nephrogenic Systemic Fibrosis. A Radiologist’s Primer. Radiographics. 2020 Jan-Feb;40(1):153-162.
  • Birkeland SA, Løkkegaard H, Storm HH. Cancer risk in patients on dialysis and after renal transplantation. Lancet 2000;355:1886- 1887.
  • Sułowicz J, Wojas PA, Ignacak E, Krzanowska K, Kuźniewski M, Sułowicz W. Comparison of theincidence of skin cancers in patients on dialysis and after kidney transplantation. Advances in Dermatology and Allergology 2017;34(2):138-142.

Hemodiyaliz Tedavisine Devam Eden Hastalarda Cilt Lezyonlarının Sıklığı ve İlişkili Faktörler: Tek Merkez Deneyimi

Yıl 2022, Cilt: 17 Sayı: 2, 134 - 139, 15.07.2022
https://doi.org/10.17517/ksutfd.1096741

Öz

Amaç: Bu çalışmada diyaliz tedavi programındaki hastalarda cilt lezyonlarının sıklığını, cilt lezyonlarının tedavi süresi, diyaliz yeterliliği, altta yatan hastalık ile ilişkisinin varlığını saptamayı amaçladık.
Gereç ve Yöntemler: Çalışmaya 244 hemodiyaliz hastası dâhil edildi. Hastalar aylık muayeneleri yapılırken gönüllü dermatoloji uzmanı tarafından muayene edildi. Veriler dosyalarından retrospektif olarak kaydedildi.
Bulgular: Çalışmaya yaş ortalaması 58±18.2 olan 244 (%58 erkek, % 42 kadın) hasta alındı. Ortalama hemodiyaliz tedavi süresi 4.2 yıldı. En sık cilt bulgusu kserozis olup hastaların %60.6’sında mevcuttu. Diğer sık görülen cilt bulguları ise sıklık sırası ile pruritis (%53), kıllarda azalma (%49.5), saç değişiklikleri
(%47.9), tırnak değişiklikleri (%42.5), ekzema (%20.9) ve hiperpigmentasyon (%8.6) olarak saptandı. Kserozis sıklığı diyabetik hasta grubunda non-diyabetik hastalara göre daha fazlaydı (p<0.001). Hastalarda saptanan cilt lezyonlarından pruritis ve kserozis ile diyaliz yeterliliği arasında (Kt/V) istatistiksel anlamlı korelasyon olduğu saptanırken (p=0.01), kalsiyum (Ca), fosfor (P), CaxP, parathormon (PTH), ferritin, albümin düzeyleri ile istatistiksel anlamlı korelasyon saptanmadı. Diyabetik ve diyabetik olmayan hastalar karşılaştırıldığında ise pruritis oranının diyabetik hasta grubunda istatistiksel anlamlı olarak daha yüksek olduğu saptandı (p=0.01). Tırnak değişiklikleri kategorisine dâhil edilen onikomikoz oranının diyabetik hasta grubunda non-diyabetik hasta grubundan istatistiksel anlamlı olarak daha yüksek oranda gözlendiği saptandı (p=0.01). Diyabetik hasta grubunda 7, diyabetik olmayan grupta ise 2 hastada olası premalign lezyon tespit edildi.
Sonuç: KBY hastalarında cilt lezyonları yaygın olarak görülmekte, cilt bulgularının prevalansı farklılık göstermekle birlikte hem prediyaliz hemde diyaliz hastalarında en sık kserozis ve pruritis olduğu bizim çalışmamızda olduğu gibi birçok çalışmada gösterilmiştir. Hemodiyaliz hasta grubunda sık karşılaşılan
cilt lezyonlarının tanınması erken tanı ve tedavi olanağı sağlayarak hastaların yaşam kalitesini artıracaktır.

Kaynakça

  • Abdelbaqi SM, Shalhub S, Morgan MB. A current review of the cutaneous manifestations of renal disease. J CutanPathol. 2003;30:527-538.
  • Leena JA, Noman MU, Islam MMSU, Ahmed AS, Ahmed DS, Rahma MM. Cutaneous Manifestations of Chronic Kidney Disease. Farid pur Med Coll J. 2012;7:33-36.
  • Nunley JR. Dermatologic manifestations of renal disease. E Med J 2002;550.
  • Lupi O, Rezende L, Zangrando M, Sessim M, Silveira CB, Sepulcri MA et al. Cutaneous manifestations in end-stage renal disease. An Bras Dermatol. 2011;86:319-326.
  • Khan R, Quaiser S, Haque SF, Sachdeva S. Cutaneous Manifestations in Patients of Chronic Kidney Disease. Int J Cur Bio Med Sci. 2011;1:113-115.
  • Nordal EJ, Os I. Uremic pruritus pathogenesis and treatment. Tidsskr Nor Laegeforen 2007;127:1201-1203.
  • Mourad B, Hegab D, Okasha K, Rizk SI. Prospectivestudy on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals. Egypt Clin Cosmet Investig Dermatol 2014;7:313–319.
  • Gammal C, Pagnoni A, Kligman AM, Gammal S. A model to assess the efficacy of moisturizers–the quantification of soap induced xerosis by image analysis of adhesive-coateddiscs (D-squames). Clin Exp Dermatol 1996;21:338-343.
  • Yaghubi R, Niloufar S, Latifee SM. Cutaneous manifestations of end stage renal disease under hemodialysis. Iran J Dermatol. 2002;5:29-34.
  • Deshmukh SP, Sharma YK, Dash K, Chaudhari NC, Deo KS. Clinico epidemiological study of skin manifestations in patients of chronic renal failure on hemodialysis. Indian Dermatol Online J. 2013;4:18-21.
  • Zucker I, Yosipovitch G, David M, Gafter U, Boner G. Prevalence and characterization of uremic pruritus in patient undergoing hemodialysis: uremic pruritus is stil a major problem for patients with end-stage renal disease. J AmAcadDermatol 2003;49:842- 846.
  • Akhyani M, Ganji M, Samadi N, Khamesan B, Daneshpazhooh M. Pruritus in hemodialysis patients. BMC Dermatology 2005;5:7.
  • Sanad EM, Sorour NE, Saudi WM, Elmasry AM. Prevalence of cutaneous manifestations in chronic renal failure patients on regular hemodialysis: a hospital based study. Egyptian J Dermatol Venereol. 2014;34:27-35.
  • Rashpa RS, Mahajan VK, Kumar P, Mehta KS, Chauhan PS, Rawat R et al. Mucocutaneous manifestations in patients with chronic kidney disease: A cross-sectional study. Indian Dermatol Online J. 2018;9:20-26.
  • Aktas SB, Atış G, Demirci GT, Çolak H. Tip II Diyabetli hastalarda Gözlenen Cilt Bulguları: Tepecik Eğit Hast Derg 2014;24(1):37-42
  • Hattem SV, Bootsma AH, Thio HB. Skin manifestations of diabetes. Cleveland ClinicJournal of medicine 2008;75(11): 772-787.
  • Landing BH, Wells TR, Williamson ML. Anatomy of eccrinesweat glands in children with chronic renal insufficiency and other fatal chronic diseases. Am J Pathol 1970;54:15-21.
  • Morton CA, Lafferty M, Hau C, Henderson I, Jones M, Lowe JG. Pruritus and skin hydration during dialysis. Nephrol Dial Transplant 1996;11:2031-2036.
  • Falodun O, Ogunbiyi A, Salako B, George A K. Skin changes in patients with chronic renal failure. Saudi J Kidney Dis Transplant 2011;22:268-272.
  • Adelakun TA, Akinsola A. Hypertension induced chronic renalfailure: Clinical features, management and prognosis. West Afr J Med 1998;17:104-108.
  • Dyachenko P, Monselise A, Shustak A, Ziv M, Rozenman D. Nail disorders in patients with chronic renal failure and undergoing haemodilysis treatment. J Eur Acad Dermatol Venereol 2007;21:340-344
  • Jamal A, Subramanian PT, Hussain KS. Nail changes in end-stage renal failure patients on hemodilysis. Saudi J Kidney Dis Transpl 2000;11:44-47.
  • Cevher ŞK, Yenigün EÇ, Yetkin H, Aypak C, Dede F. Prediyaliz Kronik Böbrek Hastalığına Eşlik Eden Cilt Lezyonları. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi: 2018: 27:157–161.
  • Udayakumar P, Balasubramainan S, Ramalingam KS, Lakshi MC, Srinivas CR, Mathew AC. Cutaneous manifestatious in patients with chronic renal failure on hemodialysis. Indian J Dermatol Venereal Leprol 2006;72:119-125.
  • Seethapathy H, Brandenburg VM, Sinha S, Azhary RA, Nigwekar SU. Review: update on themanagement of calciphylaxis. QJM. 2019;112(1):29-34.
  • Mathur M, Jones JR, Weinreb JC. Gadolinium Deposition and Nephrogenic Systemic Fibrosis. A Radiologist’s Primer. Radiographics. 2020 Jan-Feb;40(1):153-162.
  • Birkeland SA, Løkkegaard H, Storm HH. Cancer risk in patients on dialysis and after renal transplantation. Lancet 2000;355:1886- 1887.
  • Sułowicz J, Wojas PA, Ignacak E, Krzanowska K, Kuźniewski M, Sułowicz W. Comparison of theincidence of skin cancers in patients on dialysis and after kidney transplantation. Advances in Dermatology and Allergology 2017;34(2):138-142.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Eda Altun 0000-0002-5564-356X

Erken Görünüm Tarihi 11 Temmuz 2022
Yayımlanma Tarihi 15 Temmuz 2022
Gönderilme Tarihi 1 Nisan 2022
Kabul Tarihi 19 Nisan 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 17 Sayı: 2

Kaynak Göster

AMA Altun E. Hemodiyaliz Tedavisine Devam Eden Hastalarda Cilt Lezyonlarının Sıklığı ve İlişkili Faktörler: Tek Merkez Deneyimi. KSÜ Tıp Fak Der. Temmuz 2022;17(2):134-139. doi:10.17517/ksutfd.1096741