Investigation of dermatological manifestations in maintenance hemodialysis patients

Abstract

Aims: Skin findings are common in patients with both chronic kidney disease and undergoing hemodialysis. These findings are observed as nonspecific and specific dermatological manifestations. Our study aimed to describe the characteristics of dermatologic findings of patients with end-stage renal disease undergoing maintenance hemodialysis treatment and to investigate the relationship between these findings and the demographic and clinical features of those patients. Methods: Patients who were admitted to a private hemodialysis clinic in August 2023 were prospectively analyzed. Age, gender, type of vascular access, hemodialysis duration, etiology of end-stage renal disease, duration and frequency of hemodialysis sessions, dermatological findings, and the most recent complete blood count, parathyroid hormone, calcium, phosphorus, urea, and creatinine levels were examined and the findings were documented. Calcium x phosphorus levels were calculated. Statistical significance was accepted as p<0.05. Results: A total of 43 patients with chronic kidney disease undergoing maintenance hemodialysis were included in the study. 23 (53.5%) of the patients were female and 20 (46.5%) were male. The ages of the patients ranged from 28 to 86 years (mean age: 62.79±12.63). Xerosis was the most common dermatological finding with a rate of 90.7%. Hyperpigmentation was found in 46.5%, pruritus in 41.9%, nail disorders (subungual hyperkeratosis, absent lunula, koilonychia, half and half nail, onychorrhexis) in 37.2%, pallor in 30.2% and ecchymosis in 14%. In addition, 55.8% of the patients had mucosal changes (mucosal pallor, xerostomia, oral candidiasis, black hairy tongue, burning mouth), and 27.9% had hair findings (lusterless hair, sparse hair, telogen effluvium). Pruritus was more frequent in patients with higher predialysis urea levels (173.27±49.75 mg/dl vs. 137.04±38.19 mg/dl), (p<0.011). Xerosis and hair findings were more common in women (100% vs. 80%, 92% vs. 0%), (p<0.039, p<0.001). Hyperpigmentation was found more frequently in patients with long-term hemodialysis duration (median: 6.50 years vs. 2.00 years), (p<0.003). Conclusion: Dermatologic findings are frequently observed in patients under maintenance hemodialysis treatment and may have a negative impact on quality of life. Therefore, dermatologic evaluation should be considered an essential part of treatment in patients under maintenance hemodialysis.