الفهرس 
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Abstract
Chronic kidney disease-associated pruritus remains a frequent and sometimes tormenting problem in patients with advanced or end-stage renal disease.
The pathogenesis of uraemic pruritus (UP) is multifactorial. Triggering factors may include uraemia-related abnormalities (particularly involving calcium, phosphorus and parathyroid hormone metabolism), accumulation of uraemic toxins, systemic inflammation, cutaneous xerosis, and common co-morbidities such as diabetes mellitus and viral hepatitis. Recent findings suggest that the neurophysiology of itch is similar to that of pain; this has led to the hypothesis that the two phenomena also closely interact in ESRD patients, who often also experience uraemic neuropathy.
Patients with moderate to extreme pruritus were more likely to feel drained and have poor sleep quality, depression, and lower mental and physical composite scores of quality of life than patients with no or mild pruritus. Moreover, pruritus in HD patients is associated with a 17% higher mortality risk and this effect is no longer significant after adjustment for measures of sleep quality.
The management of pruritus is challenging especially when an underlying etiology cannot be identified. Owing to the poorly understood pathophysiology, the development of effective treatment modalities for pruritus has proven to be particularly difficult.
The aim of our study is to detect the Prevalence of pruritus among patients with chronic kidney disease, hemodialysis patients and post-transplantation and its correlation to laboratory investigation, demographic data and the treatment received by the patients.
In our study the incidence of pruritus was found to be high in patients in dialysis group (146 patients representing 48.7%), while the transplantation group show the least incidence of pruritus (5 patients only as 5%), lying in between patients group with CKD (19 patients as 19%), so the pruritus start to appear and progress with the advance of renal impairment to reach the maximum incidence with hemodialysis, then relived with transplantation and then reappear after many years of transplantation because of immunosuppressive drugs and loss of graft function.
We found that the most important factor in occurrence of pruritus is xerosis as there is strong relation between them, and we found also that severity of pruritus is directly related with the severity of xerosis. Neuropathy also play important role in presence of pruritus, we found association between occurrence of pruritus and HCV it may be due to the effect of HCV itself on the skin.
The level of phosphorus, calcium phosphorus product and hematocrit may play a role in presence of pruritus, as we observe that cases with itching had high level of phosphorus and calcium phosphorus product, while the hematocrit level found to be low in cases with itching.
Other factor not found to be related to pruritus in our study these factors include (age, sex, demographic data, associated diseases, BUN, creatinine, parathyroid hormone, alkaline phosphatase and calcium).
Dialysis efficacy measured in our study by urea reduction ratio (URR) found to play important role in management of pruritus as the severity of pruritus inversely related to the percent of URR.
There are many lines of treatment of pruritus however the only definite treatment is renal transplantation. Other available treatment include topical treatment as (topical corticosteroid, antihistaminic, anti-inflammatory and skin emollient) and systemic treatment include antihistaminic and gabapentin.
Our study shows that gabapentin is the most effective treatment for pruritus, so we can consider this drug as a promising drug in treatment of this distressing complain.
Finally, physical therapies, including UV radiation, may also have a role in patients with refractory symptoms.