Promoting Excellence : Treatment Protocol for Pruritis in ESRD

Name:
Renal Palliative Care Initiative: Treatment Protocol for Pruritis in ESRD

Description:
This treatment protocol was created to address and manage occurrence of pruritis in patients with end stage renal disease.

Category:
Clinical Care Tools - Symptom Management

Source:
Renal Palliative Care Initiative
Baystate Medical Center
759 Chestnut Street S2669
Springfield, MA 01199

Contact:
Michael Germain, M.D.
Michael.germain@bhs.org

How the grantee used this instrument:
This protocol was made available at the clinics and renal unit nursing stations.

Keywords:
esrd, end stage renal disease, pruritis, dialysis, kidney disease, symptom assessment

To use this tool:
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References:

1. Mettang, T, Fritz, P, Weber, J, et al. "Uremic prutitius in patgients on heomdialysis or continuous ambulatory peritoneal dialysis: The role of plasma histamine and skin mast cells." Clinical Nephrology, 1990; 34:136.
2. Hampers, CL, Katz, AI, Wilson, RE, Merrill, JP. "Disappearance of uremic itrching after subtotal parathyroidectomy." New England Journal of Medicine, 1968; 279:695.
3. Cawley, IP, Hoch-Ligeti, C, Bond, GM. "The eccrine sweat glands of patients in uremia." Arch Dermatol, 1961; 84:51.
4. Massry, SG, Popovtzer, MM, Coburn, Jw, et al. "Intractable pruritus as a manifestation of secondary hyperparathyroidism in uremia." New England Journal of Medicine, 1968; 279:697.
5. Parfitt, AM, Massry, SG, Winfield, AC, et al. "Disordered calcium and phosphorus metabolism during maintenance hemodialysis." American Journal of Medicine, 1971; 51:319.
6. Blachley, JD, Blankenship, M, Menter, A, ET AL. "Uremic prutitus: Skin divalent ion content and response to ultraviolet therapy." American Journal of Kidney Diseases, 1985; 5:237.
7. Hiroshige, K, Kabashima, N, Takasugi, M, Kuroiwa, A. "Optimal dialysis improves uremic pruritis." American Journal of Kidney Diseases, 1995; 25:413.
8. De Marchi, S, Ceddhin, E, Villaltgra, D, et al. "Relief of pruritis and decreases in plasma histamine concentrations during erythropoietin therapy in patients with uremia." New England Journal of Medicine, 1992; 326:969.
9. Kessler, M, Moneret-Vautrin, DA, Cao-Huu, T, et al. "Dialysis pruritis and sensitization." Nephron, 1992; 12:330.
10. Robertson, K, & Mueller, B. "Uremic pruritis." American Journal of Health-System Pharmacy, 1996; 53:2159.
11. Peer, G, Kivity, S, Agami, O, et al. "Randomised crossover trial of naltrexone in uraemic pruritis." Lancet, 1996;348: 1552.
12. Silva, S.R.B., Vianna,P.C.F, Lagon, N.V., et al. "Thalidomide for the Treatment of Uremic Pruritis: A Crossover Randomized Double-Blind Trail." Nephron, 1994;67:270-74
13. Tarng, DC, et al. "Hemodialysis-related pruritis: a double-blind, placebo-controlled, crossover study of capsaicin 0.025% cream." Nephron, 1996; 72:617.
14. Balaskas, E, Bamihas, G, Karamouzis, M, et al. "Histamine and serotonin in uremic pruritis: effect of ondansetron in CAPD-pruritic patients." Nephron, 1998; 78:395.
15. Francos, G, Kauh, V, Grittlen, S, "Elevated plasma histamine in chronic uremia: effects of ketotifen on prutitus." International Journal of Dermatology, 1991; 30:884.
16. Silverberg, D, Ianina, A, Reisin, E, "Cholestryramine in uraemic pruritis." British Medical Journal, 1997; 1:752.
17. Giovanetti, S, Barsotti, G, Cupisti, A, "Oral activated charcoal inpataients with uremic pruritis." Nephron, 1995; 70:193.
18. Schultz, B, & Roenigk, K, "Uremic pruritus treated with ultraviolet light." Journal of the American Medical Association, 1980; 243:1836.

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Posted April 2004

Baystate Medical Center overview page

# BMC11, type:symptom_management

Promoting Excellence in End-of-Life Care is a national program of The Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit PromotingExcellence.org for more resources.