Association of Uraemic Pruritus with Inflammation and Hepatitis Infection in Haemodialysis Patients

Background: Chronic inflammation and hepatitis C virus (HCV) infection have been implicated in the pathogenesis of uraemic pruritus in haemodialysis (HD) patients. However, each one's independent roles have not been previously studied.

Methods: A total of 321 HD patients diagnosed with end-stage renal disease with maintenance HD for >3 months were included. A visual analogue scale (VAS) was used to subjectively measure the severity of itching. Based on the VAS score, patients were divided into three groups: Group 1, no pruritus (VAS = 0); Group 2, mild to moderate pruritus (VAS 0-5) and Group 3, severe pruritus (VAS >5).

Results: There were 120 (37.4%) patients without any pruritus, 141 (43.9%) with mild to moderate pruritus and 60 (18.7%) with severe pruritus. Forty-six (14.3%) had hepatitis B virus (HBV) infection and 37 (11.5%) had hepatitis C virus (HCV) infection. The average serum high-sensitivity C-reactive protein (hsCRP) level was 0.58 mg/dl. Patients with severe pruritus had a significantly higher serum hsCRP level and more HBV or HCV infection (all P < 0.05). In the multi-variable logistic regression model, higher levels of hsCRP (OR = 3.54, P = 0.008) and HCV infection (OR = 2.77, P = 0.014) were both significant independent predictors for severe pruritus.

Conclusion: Our study demonstrated the heavy burden of pruritus in HD patients and corroborated the role of inflammation in the pathogenesis of uraemic pruritus. HCV infection is associated with severe uraemic pruritus but is independent of the serum hsCRP level in HD patients.