Dermatological Manifestations in Chronic Kidney Disease Patients on Hemodialysis

  • Dr Dorchhom Khrime Associate Professor, Department of Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences Patel Nagar, Dehradun, Uttarakhand, India
  • Dr Alok Kumar Incharge Nephrology Unit, Associate Professor, Department of Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences Patel Nagar, Dehradun, Uttarakhand, India
  • Dr Nitin Bansal Associate Professor, Department of Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences Patel Nagar, Dehradun, Uttarakhand, India
  • Dr Amar Nath Pandey Associate Professor, Department of Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences Patel Nagar, Dehradun, Uttarakhand, India
  • Dr Anil Mehta Professor and Head, Department of Dermatology, Shri Guru Ram Rai Institute of Medical and Health Sciences Patel Nagar, Dehradun, Uttarakhand, India
  • Dr Jitendra Singh Bisth Associate Professor Department of Dermatology, Shri Guru Ram Rai Institute of Medical and Health Sciences Patel Nagar, Dehradun, Uttarakhand, India
  • Dr Amit Verma Professor and Head, Department of Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences Patel Nagar, Dehradun, Uttarakhand, India
Keywords: Chronic Kidney Disease, Cutaneous Manifestations, Xerosis, Pruritus, Half and Half nail

Abstract

Background and Objective: Chronic kidney disease patients on dialysis face various cutaneous problems. Common problems are xerosis, pruritus, pallor, pigmentation changes, hair changes and nail changes. We planned to look for cutaneous alterations in our patients on maintenance dialysis.

Material and Methods: We included all patients on maintenance hemodialysis. We recorded their demographic profile and relevant investigations. All patients were examined by department of medicine and findings were confirmed by dermatologist. Specific investigations like skin biopsy, culture and sensitivity for bacterial infections, Gram's stain, potassium hydroxide mount and fungal culture were done where indicated.

Results: There was one hundred forty patients. Mean age of patients was 38.7±7.4 years. Gender ratio was 1.32:1 (male: female). Mean duration of dialysis was 11.7±5.6 months. All patients had at least one cutaneous manifestation. Thirty four (24.28%) patients had two cutaneous manifestations. Twenty one (17.85%) patients had three or more cutaneous manifestations. Xerosis was seen in 74.8% patients. Pigmentary changes were seen in 43.57% patients. Nail changes were seen in fifty seven patients. Half and half nail was seen in twenty six (18.57%) patients. Hair changes were seen in forty nine (35%) patients. Cutaneous infections were seen in forty six patients. Most common infection was dermatophytosis in twenty eight patients (20%).

Conclusion: CKD patients on dialysis suffer with multiple skin problems. Early detection of these problems like xerosis, cutaneous infection, and pruritus might result in improvement in quality of life.

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References

1. Pico MR, Lugo-Somolinos A, Sánchez JL, Burgos-Calderón R. Cutaneous alterations in patients with chronic renal failure. Int J Dermatol. 1992;31:860–3. [PubMed]

2. Udayakumar P, Balasubramanian S, Ramalingam KS, Lakshmi C, Srinivas CR, Mathew AC. Cutaneous manifestations in patients with chronic renal failure on hemodialysis.Indian J Dermatol Venerol Leprol . 2006;72(2):119-25. [PubMed]

3. Morton CA, Lafferty M, Hau C, Henderson I, Jones M, Lowe JG. Pruritus and skin hydration during dialysis. Nephron Dial Transplant 1996 Oct;11(10):2031-6. [PubMed]

4. Z. Hajheydari and A. Makhlough..Cutaneous and mucosal manifestations in patients on maintenance hemodialysis: a study of 101 patients in Sari, Iran. Iranian Journal of Kidney Diseases 2002:2(2):86–90. [PubMed]

5. Tawade N, Gokhale BB. Dermatologic manifestation of chronic renal failure. Indian J Dermatol Venereol Leprol 1996;62:155-6. [PubMed]

6. Siddappa K, Nair BK, Ravindra K, Siddesh ER. Skin in systemic disease. In: Valia RG, Valia AR, editors. IADVL Textbook and atlas of dermatology. 2nd ed. Bhalani Publishing House: Mumbai; 2000. pp. 938-84.

7. Weisman K. Graham RM. Systemic disease and the skin. In: Champion RH, Burton JL, Burns DA. Breathnach SM, editors. Rook/ Wilkinson/ Ebling Textbook of dermatology. 6th ed. Blackwell Science: Oxford; 1998. pp. 2703-58. [PubMed]

8. Graham RM, Cox NH. Systemic disease and the skin. In: Burns DA, Breathnach SM, Cox N, Griffiths CE, editors. Rook's textbook of dermatology. 7 th ed. Oxford: Wiley-Blackwell; 2004: pp.59-75.

9. Gupta AK, Gupta MA, Cardella CJ, Haberman HF. Cutaneous associations of chronic renal failure and dialysis.Int J Dermatol. 1986;25(8):498-504. [PubMed]

10. Deshmukh SP, Sharma YK, Dash K, Chaudhari NC, Deo KS. Clinicoepidemiological study of skin manifestations in patients of chronic renal failure on hemodialysis. Indian Dermatol Online J 2013;4:18-21. [PubMed]

11. Kato A, Hamada M, Maruyama T, Maruyama Y, Hishida A. Pruritus and hydration state of stratum corneum in hemodialysis patients.Am J Nephrl.2000:20(6):437-42. [PubMed]

12. Etter L, Myers SA. Pruritus in systemic disease: Mechanisms and management. Dermatol Clin. 2002;20(3):459-472. [PubMed]

13. Smith AG, Shuster S, Comaish JS, Plummer NA, Thody AJ, Alvarez-Ude F. Plasma immunoreactive β-Melanocyte stimulating hormone and skin pigmentation in chronic renal failure. Br Med J 1975;1:658-9.

14. Tsaltas TT. Studies of lipochromes in uremic patients and normal controls. II. Isolation and identification of carotenoids and lipochromes and their oxidation products in plasma. Trans Am Soc Artif Intern Organs 1970;16:272-8.

15. Beheshti A, Charkhchian M, Zangivand AA, Sedighi A, Amri G. Dermatological Manifestations Among Patients on Maintenance Hemodialysis. WOUNDS. 2013;25(3):61–67.

16. Sultan MM, Mansour HH, Wahby IM, Houdery AS. Cutaneous manifestations in egyptians patients with chronic renal failure on regular hemodialysis. J Egypt Women Dermatol Soc 2010;7:49-55.

17. Dyachenko P, Monselise A, Shustak A, Ziv M, Rozenman D. Nail disorders in patients with chronic renal failure and undergoing haemodialysis treatment: A case control study. J Eur Acad Dermatol Venereol 2007;21:340-4.

18. Singh G, Singh SJ, Chakrabarthy N, Siddharaju KS, Prakash JC. Cutaneous manifestations of chronic renal failure. Indian J Dermatol Venereol Leprol 1989;55:167-9.

19. Gupta AK, Gupta MA, Cardella CJ, Haberman HF. Cutaneous associations of chronic renal failure and dialysis. Int J Dermatol 1986;25:498-504. [PubMed]

20. Cohen GS. Renal disease. In: Lynch MA, editor. Burket's Oral medicine: Diagnosis and treatment. 9th ed. Philadelphia: Lippincott-Raven; 1997: pp487-509.

21. Remuzzi G. Bleeding in renal failure. Lancet 1988;28:1205-8. [PubMed]

22. Khanna D, Singhal A, Kalra OP. Comparison of cutaneous manifestations in chronic kidney disease with or without dialysis. Postgrad Med J 2010:86:641-47. [PubMed]

23. Lindsay RM, Briggs JD, Luke RG, Boyle IT, Kennedy AC. Gynecomastia in chronic renal failure. Br Med J 1967;4:779-80.
CITATION
DOI: 10.17511/ijmrr.2014.i06.05
Published: 2014-12-31
How to Cite
1.
Khrime D, Kumar A, Bansal N, Nath Pandey A, Mehta A, Singh Bisth J, Verma A. Dermatological Manifestations in Chronic Kidney Disease Patients on Hemodialysis. Int J Med Res Rev [Internet]. 2014Dec.31 [cited 2024Jul.3];2(6):529-33. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/154
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Original Article