2012 Volume 45 Issue 12 Pages 1133-1140
Purpose: To investigate the status of uremic pruritus in hemodialysis patients and the efficacy of nalfurafine hydrochloride (nalfurafine), an opioid κ-receptor agonist, for the treatment of resistant pruritus. Methods: Hemodialysis patients recruited from 17 institutes in the Tokai area replied to the questionnaire under their own volition. They answered regarding the intensity of pruritus using the Shiratori severity score and visual analog scale (VAS), and described the frequency of pruritus and disturbance of sleep due to it. Results: The pruritus survey involved 1,936 hemodialysis patients (1,261 men and 675 women). The mean age and duration of hemodialysis were 65.1 years and 6 years and 11 months, respectively. Of the 1,927 patients who replied to the questionnaire, 1,289 (66.9%) had pruritus. The intensity of pruritus increased with an increase in its frequency (p<0.01). Sleep disturbance by pruritus was observed in 41.2% (461/1,120) of patients, and the grade of disturbance worsened with an aggravation of the intensity of pruritus (p<0.01). Nalfurafine reduced the intensity of pruritus in 63.5% (33/52) of patients. The intensity of pruritus determined by VAS (mean±SD) reduced from 70.9±22.2mm before to 39.5±29.8mm after administration (p<0.01). In addition, nalfurafine lowered the grade of sleep disturbance in 42.3% (22/52) of patients and reduced the number of patients with sleep disturbance by pruritus from 23 to 10. In particular, the number of patients with moderate or severe sleep disturbance decreased from 15 to 2 after the initiation of nalfurafine treatment. Conclusion: Uremic pruritus continues to occur in many hemodialysis patients and lowers their quality of sleep. Nalfurafine may be effective to improve pruritus.
