Usefulness of the Japanese version of the 5-D itch scale for rating pruritus experienced by patients undergoing hemodialysis
Tóm tắt
Pruritus in patients undergoing hemodialysis reduces quality of life via insomnia and depression, and negatively affects prognosis. For diagnosing pruritus, selecting therapeutic strategies, and determining therapeutic outcomes, methods are needed for objectively quantifying the degree of itchiness. In 2015, the Japanese version of the 5-D itch scale (5D-J), originally developed in the USA in 2010, was developed as a simple self-administered questionnaire; it evaluated the degree of itchiness based on five components: (1) duration of itchiness, (2) degree of itchiness, (3) direction of itchiness, (4) disability caused by itchiness, and (5) distribution of itchiness. 5D-J is useful for comprehensively assessing multiple elements related to itchiness. We used 5D-J to assess the degree of itchiness experienced by patients undergoing hemodialysis to investigate its clinical usefulness. Subjects were 336 patients undergoing maintenance hemodialysis at our facility in October 2016; they were selected from 383 patients, of whom 20 were excluded because their itchiness had a dermatologic origin and 27 were excluded because their localized itchiness was related to vascular access, respectively. The status of itchiness (duration, degree, direction, disability, and distribution) of the patients was surveyed in October 2016 using 5D-J; total scores were calculated and used for assessing the itchiness experienced by patients. We additionally investigated whether 5D-J scores correlated with visual analog scale (VAS) and Shiratori severity scores for pruritus. Degree was reported as “not present” by 124 patients (36.9%), “mild” by 164 (48.8%), “moderate” by 46 (13.7%), “severe” by 2 (0.6%), and “unbearable” by 0 (0%). Total score was 5 points in 55 patients (16.4%), 6–9 in 176 (52.4%), 10–14 in 95 (28.3%), 15–19 in 9 (2.7%), 20–24 in 1 (0.3%), and 25 in 0 (0%). The 5D-J total and VAS scores were strongly correlated (r = 0.7159; p < 0.001). The 5D-J total score correlated with “daytime itchiness” (r = 0.6441; p < 0.001) and “nighttime itchiness” (r = 0.6352; p < 0.001) on the Shiratori severity score. 5D-J may be useful for objectively assessing itchiness experienced by patients undergoing hemodialysis.
Tài liệu tham khảo
Omori K, Aoike I, Aoyagi H, Aoyagi R, Imai K, Iwafuchi Y, et al. Risk factors for uremic pruritus in long-term hemodialysis patients. J Jpn Soc Dial Ther. 2001;34:1469–77. (in Japanese)
Pisoni RL, Wikström B, Elder SJ, Akizawa T, Asano Y, Keen ML, et al. Pruritus in haemodialysis patients: international results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Transplant. 2006;21:3495–505.
Narita I, Alchi B, Omori K, Sato F, Ajiro J, Saga D, et al. Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney Int. 2006;69:1626–32.
Yamada S, Sakurai H, Kasuga H, Kawahara H. Investigation of the status of uremic pruritus in hemodialysis patients and the efficacy of nalfurafine hydrochloride―questionnaire administered to 1,936 patients from 17 clinics in Tokai area of Japan. J Jpn Soc Dial Ther. 2012;45:1133–40. (in Japanese)
Kimata N, Fuller DS, Saito A, Akizawa T, Fukuhara S, Pisoni RL, et al. Pruritus in hemodialysis patients: results from the Japanese Dialysis Outcomes and Practice Patterns Study (JDOPPS). Hemodial Int. 2014;18:657–67.
Remakrishnan K, Bond TC, Claxton A, Sood VC, Kootsikas M, Agnese W, et al. Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms. Int J Nephrol Renovasc Dis. 2014;7:1–12.
Mathur VS, Lindberg J, Germain M, Block G, Tumlin J, Smith M, et al. ITCH National Registry Investigators: a longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol. 2010;5:1410–9.
Shirazian S, Aina O, Park Y, Chowdhury N, Leger K, Hou L, et al. Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges. Int J Nephrol Renovasc Dis. 2017;10:11–26.
Furue M, Ebata T, Ikoma A, Takeuchi S, Kataoka Y, Takamori K, et al. Verbalizing extremes of the visual analogue scale for pruritus: a consensus statement. Acta Derm Venereol. 2013;93:214–21.
Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14:798–804.
Reich A, Heisig M, Phan NQ, Taneda K, Takamori K, Takeuchi S, et al. Visual analogue scale: evaluation of the instrument for the assessment of pruritus. Acta Derm Venereol. 2012;92:497–501.
Phan NQ, Blome C, Fritz F, Gerss J, Reich A, Ebata T, et al. Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus. Acta Derm Venereol. 2012;92:502–7.
Shiratori A. Therapeutic outcomes of the use of mequitazine (LM-209) in severe dermatological diseases. Nishinihon J Dermatol. 1983;45:470–3. (in Japanese)
Kawashima M, Tango T, Noguchi T, Inagi M, Nakagawa H, Harada S. Addition of fexofenadine to a topical corticosteroid reduces the pruritus associated with atopic dermatitis in a 1-week randomized, multicentre, double-blind, placebo-controlled, parallel-group study. Br J Dermatol. 2003;148:1212–21.
Ständer S, Augustin M, Reich A, Blome C, Ebata T, Phan NQ, et al. Pruritus assessment in clinical trials: consensus recommendations from the International Forum for the Study of Itch (IFSI) Special Interest Group Scoring Itch in Clinical Trials. Acta Derm Venereol. 2013;93:509–14.
Ebata T, Ishiuji Y, Saeki H, Nakagawa H. Creation of a Japanese version of the 5D itch scale. Jpn J Dermatol. 2015;125:1035–40. (in Japanese)
Elman S, Hynan LS, Gabriel V, Mayo MJ. The 5-D itch scale: a new measure of pruritus. Br J Dermatol. 2010;162:587–93.
Ebata T. Recent advances in the evaluation of itch and introduction of the Japanese version of the 5D-itch scale in adult patients with atopic dermatitis; Atopic Dermatitis Treatment Study Group. Skin Res. 2015;14:S1–6. (in Japanese)
Chiu YL, Chen HY, Chuang YF, Hsu SP, Lai CF, Pai MF, et al. Association of uraemic pruritus with inflammation and hepatitis infection in haemodialysis patients. Nephrol Dial Transplant. 2008;23:3685–9.
Takahashi N, Yoshizawa T, Kumagai J. Efficacy and safety of long-term (104-week) administration of nalfurafine hydrochloride. J Jpn Soc Dial Ther. 2013;46:371–8. (in Japanese)
Takahashi N, Yoshizawa T, Kumagai J, Kawanishi H, Moriishi M, Masaki T, et al. Response of patients with hemodialysis-associated pruritus to new treatment protocol with nalfurafine hydrochloride: a retrospective survey-based study. Ren Replac Ther. 2016;2:27.
Lai JW, Chen HC, Chou CY, Yen HR, Li TC, Sun MF, et al. Transformation of 5-D itch scale and numerical rating scale in chronic hemodialysis patients. BMC Nephrol. 2017;18:56.