1
|
Afsar B, Afsar RE. Hypersensitive Reactions During Hemodialysis Treatment: What Do We Need to Know? Semin Dial 2024; 37:189-199. [PMID: 38433728 DOI: 10.1111/sdi.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
Kidney replacement therapies (KRTs) including hemodialysis (HD) are one of the treatment options for most of the patients with end-stage kidney disease. Although HD is vital for these patients, it is not hundred percent physiological, and various adverse events including hypersensitivity reactions may occur. Fortunately, these reactions are rare in total and less when compared to previous decades, but it is still very important for at least two reasons: First, the number of patients receiving kidney replacement treatment is increasing globally; and the cumulative number of these reactions may be substantial. Second, although most of these reactions are mild, some of them may be very severe and even lead to mortality. Thus, it is very important to have basic knowledge and skills to diagnose and treat these reactions. Hypersensitivity reactions can occur at any component of dialysis machinery (access, extracorporeal circuit, medications, etc.). The most important preventive measure is to avoid the allergen. However, even with very specific test, sometimes the allergen cannot be found. In mild conditions, HD can be contained with non-specific treatment (topical creams, antihistaminics, corticosteroids). In more severe conditions, treatment must be stopped immediately, blood should not be returned to patient, drugs must be stopped, and rules of general emergency treatment must be followed.
Collapse
Affiliation(s)
- Baris Afsar
- Department of Nephrology, School of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Rengin Elsurer Afsar
- Department of Nephrology, School of Medicine, Suleyman Demirel University, Isparta, Turkey
| |
Collapse
|
2
|
Batta S, Preston A, Bicknell L. New Arteriovenous Skin Rash in a Patient with ESKD on Dialysis. Kidney360 2023; 4:423-424. [PMID: 36996304 PMCID: PMC10103343 DOI: 10.34067/kid.0000000000000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/12/2022] [Indexed: 04/01/2023]
Affiliation(s)
| | - Allie Preston
- Baylor Scott & White Medical Center, Department of Dermatology, Temple, Texas
| | - Lindsay Bicknell
- Baylor Scott & White Medical Center, Department of Dermatology, Temple, Texas
| |
Collapse
|
3
|
Abstract
Pain on arteriovenous fistula (AVF) cannulation is a rather persistent problem in the daily hemodialysis practice. Its prevalence varies from 12% to even 80% depending on the definition and the pain-assessment tools and it affects the quality of life of hemodialysis patients. It is associated with fear of the cannulation process, the decision of hemodialysis from an AVF and sometimes the hemodialysis itself. In this narrative review, we tried to tackle the extent of the problem and to present the available published solutions. The literature suggests a large array of methods based on the application of local anesthetic creams, application of cold or hot directly on the cannulation sites or on the contralateral arm, cannulation techniques and AVF localization, distraction as well as alternative treatments. All of them have shown a relative success. There is a serious lack of large multicenter randomized trials and a gap concerning work groups and guidelines or recommendations from national or international societies on this matter. Complementary training starting from the predialysis patient education programs may be useful. Alternative prophylactic measures including counseling, hypnosis, or other physicochemical interventions could also improve our knowledge on the treatment of this seriously uncomfortable condition.
Collapse
|
4
|
Sallée M, Mercadal L, Jean G, Guery B, Borniche D, Charrel JM, Hannedouche T, Roy FL, Brunet P. Vascular access cannulation and haemostasis: a national observational study of French practices. Clin Kidney J 2021; 14:1261-1268. [PMID: 33841870 PMCID: PMC8023177 DOI: 10.1093/ckj/sfaa098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/11/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We report the results of an observational study of arteriovenous fistula (AVF) cannulation and haemostasis practices in France. METHODS The study (sponsored by Brothier Pharmaceutical Inc.) was conducted in 150 dialysis units. Data obtained from 150 supervisory nurses, 1538 nurses and 3588 patients with an AVF were analysed. RESULTS The nurses reported using rope-ladder, area or buttonhole cannulation techniques in 68, 26 and 6% of cases, respectively. Metal needles were used most frequently (64%), with mainly a diameter of 15 G or 16 G. The needle was introduced with the bevel up in 56% of cases. Compression applied using dressings (in particular, pure calcium alginate dressings) was the method of choice for haemostasis of the puncture sites and was assessed as being strong by most of the nurses and very strong in cases of prolonged bleeding. Most (82%) of the patients reported the use of local anaesthetic before cannulation and 23% reported an allergic skin reaction to the anaesthetic. Bleeding of the puncture sites lasted for >10 min for 48% of the patients and it reappeared between two sessions for 29% of the patients. Whereas the nurses appeared to have a good understanding of AVF, more than half of the patients did not know how to care for it, with 55% requiring more information. CONCLUSIONS This study underlines the lack of national consensus concerning AVF cannulation practices. It suggests that haemostasis methods of the puncture sites can be improved and it highlights the need to improve patient knowledge.
Collapse
Affiliation(s)
- Marion Sallée
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France
- C2VN, Aix Marseille Univ, INSERM, INRAE, Marseille, France
| | - Lucile Mercadal
- Department of Nephrology, hôpital universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Bruno Guery
- Department of Nephrology-adult dialysis, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Didier Borniche
- AFIDTN, French Association of Nurses for Dialysis, Transplantation and Nephrology, Bihorel, France
| | | | - Thierry Hannedouche
- Department of Nephrology and Haemodialysis, Hôpitaux Universitaires de Strasbourg & Faculté de Médecine, Strasbourg, France
| | - Frank Le Roy
- Department of Nephrology University, Centre Hospitalier Universitaire de Rouen, France
| | - Philippe Brunet
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France
- C2VN, Aix Marseille Univ, INSERM, INRAE, Marseille, France
| |
Collapse
|
5
|
Kaida Y, Minami A, Matsue-Fukuyama M, Adachi T, Nagata H, Ishii N, Nakama T, Fukami K. Erythema and Swelling Around Arteriovenous Fistula Sites in a Hemodialysis Patient. Am J Kidney Dis 2018; 71:A10-A11. [PMID: 29685213 DOI: 10.1053/j.ajkd.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/08/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Yusuke Kaida
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
| | - Aki Minami
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Misako Matsue-Fukuyama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Takeki Adachi
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Hiroshi Nagata
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Takekuni Nakama
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Kei Fukami
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| |
Collapse
|
6
|
Rodríguez-Sanz A, Sánchez-Villanueva R, Domínguez-Ortega J, Fiandor AM, Ruiz MP, Trocoli F, Díaz-Tejeiro R, Cadenillas C, González E, Martínez V, López-Trascasa M, Quirce S, Selgas R, Bellón T. Mechanisms Involved in Hypersensitivity Reactions to Polysulfone Hemodialysis Membranes. Artif Organs 2017; 41:E285-E295. [DOI: 10.1111/aor.12954] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 12/23/2022]
Affiliation(s)
| | | | | | - Ana-María Fiandor
- Hospital La Paz Health Research Institute-IdiPAZ-Research; Madrid Spain
| | - María-Paz Ruiz
- Hospital La Paz Health Research Institute-IdiPAZ-Research; Madrid Spain
| | - Filomena Trocoli
- Hospital La Paz Health Research Institute-IdiPAZ-Research; Madrid Spain
| | | | - Carlos Cadenillas
- Hospital La Paz Health Research Institute-IdiPAZ-Research; Madrid Spain
| | - Elena González
- Hospital La Paz Health Research Institute-IdiPAZ-Research; Madrid Spain
| | - Virginia Martínez
- Hospital La Paz Health Research Institute-IdiPAZ-Research; Madrid Spain
| | | | - Santiago Quirce
- Hospital La Paz Health Research Institute-IdiPAZ-Research; Madrid Spain
| | - Rafael Selgas
- Hospital La Paz Health Research Institute-IdiPAZ-Research; Madrid Spain
| | - Teresa Bellón
- Hospital La Paz Health Research Institute-IdiPAZ-Research; Madrid Spain
| |
Collapse
|
7
|
Abstract
Itch, or pruritus, is a hallmark feature of atopic dermatitis (AD). The impact of AD-related pruritus can range from mildly distressing or distracting to completely disabling. Traditionally, management of itch in AD patients has focused on restoring the altered skin barrier with topical emollients and/or reducing inflammation. A growing emphasis has been placed on directly targeting the neural transmission pathways that mediate itch signaling. Off-label use of neuromodulatory agents has helped reduce this aggravating symptom in atopic patients. This article reviews the current literature on the use of neuromodulatory agents and nonpharmacologic alternative therapies used to treat AD-related pruritus.
Collapse
Affiliation(s)
- Sarina B Elmariah
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| |
Collapse
|
8
|
Butani L, Calogiuri G. Hypersensitivity reactions in patients receiving hemodialysis. Ann Allergy Asthma Immunol 2017; 118:680-684. [PMID: 28456484 DOI: 10.1016/j.anai.2017.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe hypersensitivity reactions in patients receiving maintenance hemodialysis. DATA SOURCES PubMed search of articles published during the past 30 years with an emphasis on publications in the past decade. STUDY SELECTIONS Case reports and review articles describing hypersensitivity reactions in the context of hemodialysis. RESULTS Pharmacologic agents are the most common identifiable cause of hypersensitivity reactions in patients receiving hemodialysis. These include iron, erythropoietin, and heparin, which can cause anaphylactic or pseudoallergic reactions, and topical antibiotics and anesthetics, which lead to delayed-type hypersensitivity reactions. Many hypersensitivity reactions are triggered by complement activation and increased bradykinin resulting from contact system activation, especially in the context of angiotensin-converting enzyme inhibitor use. Several alternative pharmacologic preparations and dialyzer membranes are available, such that once an etiology for the reaction is established, recurrences can be prevented without affecting the quality of care provided to patients. CONCLUSION Although hypersensitivity reactions are uncommon in patients receiving hemodialysis, they can be life-threatening. Moreover, considering the large prevalence of the end-stage renal disease population, the implications of such reactions are enormous. Most reactions are pseudoallergic and not mediated by immunoglobulin E. The multiplicity of potential exposures and the complexity of the environment to which patients on dialysis are exposed make it challenging to identify the precise cause of these reactions. Great diligence is needed to investigate hypersensitivity reactions to avoid recurrence in this high-risk population.
Collapse
Affiliation(s)
- Lavjay Butani
- University of California Davis Medical Center, Sacramento, California.
| | | |
Collapse
|
9
|
Chasset F, Pecquet C, Cury K, Sesé L, Moguelet P, Francès C, Gharbi C, Senet P. [Bullous rash around a peritoneal dialysis catheter exit site]. Ann Dermatol Venereol 2015; 142:438-42. [PMID: 25999261 DOI: 10.1016/j.annder.2015.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 01/12/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cutaneous eruption around a peritoneal dialysis (PD) catheter exit site is a rare complication. Herein we report a case of bullous eruption; we discuss the diagnostic approach and the related therapeutic implications. PATIENTS AND METHODS A 63-year-old man presented a bullous periumbilical eruption two months after initiation of PD. Cultures of laboratory samples ruled out an infectious origin and systemic corticosteroids initiated at 0.5mg/kg for suspected eosinophilic peritonitis produced significant improvement of the cutaneous eruption. Recurrence of the bullous eruption was observed upon dose-reduction of the corticosteroid. Skin histology showed a clinical picture of eczema and direct immunofluorescence was negative. Patch testing was carried out using the European Standard Battery comprising antiseptic, cosmetic and plastic series; a semi-open test was performed with the dressing used for PD, and ROAT was carried out on the povidone iodine (Betadine™) 10% used for topical care during PD. The patch testing and ROAT were positive (++), confirming contact dermatitis due to Betadine™. The eruption totally disappeared on substitution of Betadine™ by chlorhexidine for topical antisepsis of the PD catheter, thus enabling PD to be continued rather than instituting hemodialysis. DISCUSSION Allergic contact dermatitis around a PD catheter is a rare and little-known complication. In the present case, ROAT testing showed sensitization to Betadine™ and enabled an alternative antisepsis solution to be found, allowing PD to be continued.
Collapse
|
10
|
Pastor-Nieto MA, Alcántara F, Ballano A, Vergara A, Belmar P, Sánchez-Herreros C, Martín-Fuentes A, Jiménez E, De Eusebio E. Allergic contact dermatitis resulting from a poly(carbonate urethane) chronic haemodialysis central venous catheter. Contact Dermatitis 2014; 72:124-6. [DOI: 10.1111/cod.12325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/22/2014] [Accepted: 11/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Maria A. Pastor-Nieto
- Dermatology Department; University Hospital of Guadalajara; C/. Donantes de Sangre s/n 19002 Guadalajara Spain
| | - Francisco Alcántara
- Dermatology Department; University Hospital of Guadalajara; C/. Donantes de Sangre s/n 19002 Guadalajara Spain
| | - Adrián Ballano
- Dermatology Department; University Hospital of Guadalajara; C/. Donantes de Sangre s/n 19002 Guadalajara Spain
| | - Aránzazu Vergara
- Dermatology Department; University Hospital of Guadalajara; C/. Donantes de Sangre s/n 19002 Guadalajara Spain
| | - Paulina Belmar
- Dermatology Department; University Hospital of Guadalajara; C/. Donantes de Sangre s/n 19002 Guadalajara Spain
| | - Consuelo Sánchez-Herreros
- Dermatology Department; University Hospital of Guadalajara; C/. Donantes de Sangre s/n 19002 Guadalajara Spain
| | - Adriana Martín-Fuentes
- Dermatology Department; University Hospital of Guadalajara; C/. Donantes de Sangre s/n 19002 Guadalajara Spain
| | - Ester Jiménez
- Dermatology Department; University Hospital of Guadalajara; C/. Donantes de Sangre s/n 19002 Guadalajara Spain
| | - Esther De Eusebio
- Dermatology Department; University Hospital of Guadalajara; C/. Donantes de Sangre s/n 19002 Guadalajara Spain
| |
Collapse
|
11
|
Shu KH, Kao TW, Chiang WC, Wu VC. A case of anaphylactic shock induced by FX60 polysulfone hemodialyzer but not F6-HPS polysulfone hemodialyzer. Hemodial Int 2014; 18:841-5. [DOI: 10.1111/hdi.12184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kai-Hsiang Shu
- Division of Nephrology; Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Tze-Wah Kao
- Division of Nephrology; Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Wen-Chih Chiang
- Division of Nephrology; Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Vin-Cent Wu
- Division of Nephrology; Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| |
Collapse
|
12
|
Hwang YJ, Yun MO, Jeong KT, Park JH. Uremic toxin indoxyl 3-sulfate regulates the differentiation of Th2 but not of Th1 cells to lessen allergic asthma. Toxicol Lett 2013; 225:130-8. [PMID: 24291743 DOI: 10.1016/j.toxlet.2013.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/19/2013] [Accepted: 11/21/2013] [Indexed: 01/01/2023]
Abstract
Immune system dysfunctions including the increased Th1/Th2 ratio are common in chronic kidney disease (CKD) patients, and a wide variety of skin diseases including Th1-mediated uremic pruritis are associated with CKD. Although there are more than 90 uremic toxins reported, it is yet to be known which uremic solute is associated with the unbalanced Th1/Th2 ratio and how it works. Indoxyl 3-sulfate (I3S), one of uremic toxins and a potent aryl hydrocarbon receptor (AhR) ligand, accumulates in blood and tissues, increasing up to 81.04 μM in CKD patients, compared with 1.03 μM in healthy subjects. I3S activates NF-κB and AhR. Thus, we investigated roles of I3S in the differentiation of Th1 and Th2 cells. I3S inhibited Th2 differentiation but showed little or no effect on Th1 differentiation. I3S suppressed Th2-mediated ovalbumin-induced allergic asthma in mice and decreased the frequency of IL-4 producing CD4 T cells in the lungs. I3S inhibited phosphorylation of STAT5 and STAT6, transcription factors associated with Th2 differentiation. Effects of I3S on Th2 differentiation were suppressed by α-naphtoflavone, an AhR antagonist, indicating that I3S regulates Th2 differentiation AhR-dependently.
Collapse
Affiliation(s)
- You-Jung Hwang
- Department of Biology, Changwon National University, Kyungnam, Changwon, 641-773, South Korea
| | - Mi-Ok Yun
- Department of Biology, Changwon National University, Kyungnam, Changwon, 641-773, South Korea
| | - Kyu-Tae Jeong
- Department of Biology, Changwon National University, Kyungnam, Changwon, 641-773, South Korea
| | - Joo-Hung Park
- Department of Biology, Changwon National University, Kyungnam, Changwon, 641-773, South Korea.
| |
Collapse
|
13
|
|
14
|
Moneret-Vautrin DA, Codreanu F, Drouet M, Plaud B, Karila C, Valfrey J, Debaene B, Malinovsky JM, Mertes JM. [Allergologic screening and management of patients with previous self-reported hypersensitivity reactions. Société française d'anesthésie et réanimation. Société française d'allergologie]. ACTA ACUST UNITED AC 2011; 30:246-63. [PMID: 21397445 DOI: 10.1016/j.annfar.2011.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D-A Moneret-Vautrin
- Service de médecine interne, immunologie clinique et allergologie, hôpital central, avenue du Maréchal de-Lattre-de-Tassigny, Nancy cedex, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Lavaud F, Mouton C, Ponvert C. Les tests cutanés dans le bilan diagnostique des réactions d’hypersensibilité peranesthésiques. ACTA ACUST UNITED AC 2011; 30:264-79. [DOI: 10.1016/j.annfar.2010.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
16
|
Abstract
UNLABELLED Introduction. Patients often report symptoms during haemodialysis (HD). To better understand patients' experience, we surveyed routine HD outpatients, to quantify the burden and duration of dialysis-associated symptoms. METHODS Five hundred and eight symptom questionnaires were returned from 550 HD outpatients (92.4%). The symptoms in relation to the HD session were analysed using a visual analogue score. Multivariate logistical regression analysis was used to identify characteristics associated with total symptom burden and time to recover following a HD session. RESULTS Fifty-four percent of the cohort were male, median age 64 years, 36% diabetic and median age unadjusted Charlson comorbidity score 3.0 (2-5). Fatigue (82%), intradialytic hypotension (76%), cramps (74%) and dizziness (63%) were the commonest symptoms reported, followed by headache (54%), pruritus (52%) and backache (51%), with fatigue occurring with a median frequency of 50% of dialysis sessions and intradialytic hypotension and cramps in 30%. Some 23% reported recovering from dialysis within minutes, 34% by the time they returned home, 16% by bed time, 24% the following morning and 3% just before the next dialysis session. Symptom burden was associated with female sex, younger age, longer duration of dialysis sessions, ethnicity and dialysis centre practice. The time taken to recover from dialysis varied from minutes to hours and was shorter for men and greater dialysis vintage but longer with increasing session time and those with increased intradialytic symptom burden. CONCLUSIONS Despite advances in HD, intradialytic symptoms were frequently reported by our patients. There was substantial unexplained variation in symptom burden across centres, suggesting that clinical practice or policies may play a role in preventing the adverse effects of dialysis. Symptom burden was worse in women, patients of South Asian as opposed to African origin and also in those receiving a longer duration of dialysis. These patients may therefore benefit from a different approach to dialysis prescription.
Collapse
Affiliation(s)
- Ben Caplin
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | | | | |
Collapse
|
17
|
Çelik G, Özbek O, Yılmaz M, Duman I, Özbek S, Apiliogullari S. Vapocoolant spray vs lidocaine/prilocaine cream for reducing the pain of venipuncture in hemodialysis patients: a randomized, placebo-controlled, crossover study. Int J Med Sci 2011; 8:623-7. [PMID: 22022215 PMCID: PMC3198258 DOI: 10.7150/ijms.8.623] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 07/27/2011] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Patients undergoing hemodialysis are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula. This study was designed to measure pain associated with venepuncture during AVF cannulation and to compare the effectiveness of ethyl chloride vapocoolant spray, topical eutectic mixture of local anesthetics (EMLA) cream and placebo in controlling pain caused by venepuncture of arteriovenous fistula patients undergoing chronic hemodialysis. METHODS This randomized, placebo-controlled, crossover study, included 41 patients undergoing conventional hemodialysis three times a week. First intervention was conducted as baseline pain assessment (control). In the three consecutive dialysis sessions, every patient randomly received 1) ethyl chloride vapocoolant spray, 2) EMLA, or 3) placebo cream before venepuncture. Pain perception was recorded by patients immediately after cannulation on a 0-100 mm visual analogue scale (VAS). p<0.05 was considered as significant. RESULTS VAS scores presented a marked inter-individual variation during venepuncture. EMLA application resulted in significantly lower total pain scores compared to control and all other interventions (p<0.05). No patient experienced severe pain with EMLA or vapocoolant. The patients reported less moderate and severe pain with EMLA, and vapocoolant spray compared to control and placebo interventions. Moderate and severe pain scores were similar between EMLA and vapocoolant spray (p>0.05). CONCLUSION Venipuncture for AVF cannulation causes mild to moderate pain in hemodialysis patients. Although local application of EMLA is more effective than in preventing venepuncture pain, ethyl chloride vapocoolant is as effective as EMLA for preventing mild to moderate puncture pain in patients undergoing hemodialysis.
Collapse
Affiliation(s)
- Gülperi Çelik
- Department Internal Medicine, Division of Nephrology, Faculty of Medicine, Selcuk University, Konya, Turkey.
| | | | | | | | | | | |
Collapse
|
18
|
Current world literature. Curr Opin Allergy Clin Immunol 2009; 9:482-8. [PMID: 19690478 DOI: 10.1097/ACI.0b013e3283312f84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Shah V, Taddio A, Rieder MJ. Effectiveness and tolerability of pharmacologic and combined interventions for reducing injection pain during routine childhood immunizations: Systematic review and meta-analyses. Clin Ther 2009; 31 Suppl 2:S104-51. [DOI: 10.1016/j.clinthera.2009.08.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2009] [Indexed: 11/16/2022]
|