Peer-review started: April 25, 2018
First decision: May 8, 2018
Revised: June 26, 2018
Accepted: June 28, 2018
Article in press: June 28, 2018
Published online: August 7, 2018
Processing time: 104 Days and 14.4 Hours
Uremic pruritus is a common and troublesome entity in patients on peritoneal dialysis. The presence of pruritus affects both sleep quality and overall lifestyle, which can lead to depressive symptoms and mood disorders. In patients with difficult-to-treat pruritus, narrow band ultraviolet B (NB-UVB) can be tried as a treatment option. There is only one randomized controlled trial that has compared the role of NB-UVB in uremic pruritus. There is very limited data regarding the use of NB-UVB in the peritoneal dialysis population. There is therefore an urgent need to identify the effectiveness of such a treatment modality in the peritoneal dialysis population.
With the limited data available, there is no clear-cut consensus regarding the role of NB-UVB in peritoneal dialysis patients who have severe pruritus. The most effective and optimal duration of treatment is also not clear. A previous randomized trial had used a course of three times a week for 6 wk. However, that study mixed in a population of chronic kidney disease patients and also included patients on hemodialysis, peritoneal dialysis, as well as patients who were treated conservatively and had not been initiated on dialysis. There were only three patients in this study who were on peritoneal dialysis, so the results therefore cannot be extrapolated to the peritoneal dialysis population. In this study, we selected a homogenous population of patients with end-stage renal disease who were on peritoneal dialysis with severe uremic pruritus, and used NB-UVB as an add-on therapy to the standard treatment.
The purpose of our study was to assess the effectiveness of NB-UVB as an add-on therapy to standard treatment in peritoneal dialysis patients with refractory uremic pruritus. We included a follow-up 6 mo post-treatment completion to assess for relapse. Patients were also given a feedback form to highlight their experience with the treatment protocol and solicit their suggestions to improve the quality of treatment.
This is a retrospective study where peritoneal dialysis patients with refractory uremic pruritus were put on a 12 wk course of NB-UVB, in addition to their standard treatment. We used visual analogue scale (VAS) to record the intensity of pruritus, which was measured during each visit. After the completion of their treatment protocol, patients were followed-up on a monthly basis for six months, and their VAS scores were measured during these visits. The patient feedback forms were also collected during these follow-up visits.
In this study, we noted that the mean VAS score improved from a baseline of 7.75 ± 1.02 to 3.14 ± 1.59 by the end of treatment. Nineteen out of the 21 patients who completed the study had improvement in symptoms. In three patients (14.2%), complete resolution of pruritus was noted. Two patients (9.5%) continued to have persistent pruritus, with VAS scores greater than five. Six (31.5%) of those patients who showed improvement in pruritus ultimately relapsed. The mean VAS score at the end of the 6 mo follow-up was 4.14 ± 2.85, which was significantly lower than the baseline VAS score (P < 0.001).
In this study, we found that NB-UVB therapy is effective as an add-on therapy in difficult-to-treat patients with uremic pruritus in the peritoneal dialysis population. In our study, we used a 12 wk treatment protocol that showed effective results. We noted that the response at 6 wk was suboptimal, and many of our patients would have been classified as non-responders if our treatment was confined to 6 wk period. However, patient compliance was poor, and the frequent visits to the hospital for treatment became an issue when we used the 12 wk regime. We therefore need to come up with an effective treatment regime that will also be acceptable to patients.
Future studies should try alternative treatment regimes, such as two times per wk for 10 wk, or three times per wk for 8 wk.