EVALUAREA PRURITULUI LA PACIENŢII DIALIZAŢI

Abstract

Introducere. Pruritul la pacienţii hemodializaţi are o pa-togeneză complexă şi afectează semnificativ calitatea vieţii. Acesta este considerat un factor de risc independent, asociat mortalităţii. Reducerea intensităţii pruritului reprezintă o opţiune reală de creştere a satisfacţiei pacientului dializat. Scop. Scopul lucrării a constat în evaluarea prevalenţei şi severităţii pruritului la pacienţii cu boală cronică de rinichi în program de hemodializă, pentru a evidenţia impactul clinic al acestuia. Material şi metode. Chestionarul de apreciere a pruritului a fost completat cu ajutorul psihologului de către 326 pacienţi în CDC1 (Centrul de Dializă Chişinău 1), 99 CDC2 (Centrul de Dializă Chişinău 2), 162 CDB (Bălţi) şi 22 CDCa (Cahul). Pacienţii au evaluat severitatea pruritului pe o scală de la 0 la 10. Rata de completare a fost >95% în toate centrele. Rezultate. Mediile severităţii pruritului au fost egale cu 2,10±0,14 (M±SE) (CDC1) (p<0,01), cu 2,76±0,46 (CDC2), cu 1,57±0,20 (CDB) (p<0,001) şi cu 2,68±0,79 (CDCa). Pruritul sever (apreciat ca intensitate de către pacienţi cu 7-10 puncte) a fost raportat de 7,6% pacienţi (CDC1), de 20,3% bolnavi (CDC2) (p<0,05), de 8,0% pacienţi (CDB) şi de 13,6% bolnavi (CDCa). Pruritul a fost complet absent la 41,4% pacienţi (CDC1) (p<0,05), la 54,5% bolnavi (CDC2), la 63,0% pacienţi (CDB) şi 36,4% persoane (CDCa) (p<0,05). Pruritul a fost considerat permanent de 30,7% pacienţi (CDC1), de 23,2% bolnavi (CDC2), de 5,6% persoane (CDB) şi 31,8% pacienţi (CDCa). Concluzii. Pruritul este un simptom ce afectează 40 - 60% dintre pacienţii dializaţi, iar formele sale severe sunt prezente la aproximativ 1 din 10 pacienţi. Controlul eficient necesită o dializă calitativă, corecţia dezechilibrelor fosfo - calcice, cât şi tratamentul neuropatiei periferice.

Introduction. Pruritus in patients receiving hemodialysis has a complex pathogenesis and significantly reduces their quality of life. It is an independent risk factor associated with mortality. Reducing pruritus severity represents a real opportunity to improve patient satisfaction with the dialysis procedure. Objective. The aim of the study was to assess the prevalence and severity of pruritus in patients with chronic kidney disease undergoing hemodialysis, to highlight its clinical impact. Material and methods. Questionnaire for assessing pruritus severity was completed with psychologist assistance by 326 patients in CDC1 (Chişinău Dialysis Center 1), 99 in CDC2 (Chişinău Dialysis Center 2), 162 in CDB (Bălţi), and 22 in CDCa (Cahul). Patients rated pruritus severity on a scale from 0 to 10. Completion rate exceeded 95% in all centers. Results. The mean pruritus severity scores were 2.10±0.14 (M±SE) in Chişinău Dialysis Center 1 (p<0.01), 2.76±0.46 in Chişinău Dialysis Center 2, 1.57±0.20 in Balti Dialysis Center (p<0.001), and 2.68±0.79 in Cahul Dialysis Center. Severe pruritus (rated by patients as an intensity of 7-10 points) was reported by 7.6% of patients in CDC1, 20.3% in CDC2 (p<0.05), 8.0% in CDB, and 13.6% in CDCa. Pruritus was completely absent in 41.4% of patients in CDC1 (p<0.05), 54.5% in CDC2, 63.0% in CDB, and 36.4% in CDCa (p<0.05). Pruritus was considered persistent by 30.7% of patients in CDC1, 23.2% in CDC2, 5.6% in CDB, and 31.8% in CDCa. Conclusion. Pruritus is a symptom affecting 40 - 60% of patients receiving hemodialysis, with its severe forms present in approximately 1 in 10 individuals. Effective control requires a high-quality dialysis, correction of phospho-calcium imbalances, and treatment of peripheral neuropathy.