A Study Of Cutaneous Manifestations In Patients Of Chronic Kidney Disease Stage 5 Undergoing Hemodialysis And Their Correlation To Parathyroid Hormone Levels At A Tertiary Care Hospital In Belgaum, A Cross Sectional Study

Abstract

Background and objectives Chronic kidney disease stage 5 patients who are on hemodialysis present with an array of cutaneous manifestations. There have been some reports of raised parathyroid hormone levels associated with some conditions like pruritus. The aim of this study was to study the cutaneous manifestations seen in patients of chronic kidney disease stage 5 undergoing hemodialysis and to correlate them with parathyroid hormone. Materials and Methods 64 patients of chronic kidney disease stage 5 who were undergoing hemodialysis and who gave an informed consent to participate in the study were included. The study period was for 1 year. A pretested pro-forma was used which had a list of all the skin changes seen in patients of chronic kidney disease stage 5 undergoing hemodialysis. In addition to this, blood was drawn from all patients and the serum parathyroid hormone levels were tested. Other pre-existing laboratory results were also noted down. A skin biopsy was done for a patient suffering from a perforating disorder. It was sent in 10% formalin to Pathology lab and was stained with Haematoxylin and eosin. Results There were 14 females and 50 males. The dialysate used was bicarbonate solution. 59% had elevated parathyroid hormone levels. 65% had pallor, 47% had edema, 28% had itching before dialysis, 41% had itching post dialysis, 22% complained of generalized darkening post dialysis, 52% had abnormal skin turgor, 16% had 1/2 and 1/2 nail, 35% had koilonychia, 23% had Terry’s nail, 8% had Muehrcke’s lines, 39% had hairloss, 95% had xerosis, 28% had coated tongue. Among the specific disorders seen in patients of chronic kidney disease stage 5 undergoing hemodialysis, only acquired perforating dermatosis was seen. It was seen in 3 (4.7%) patients. Other specific changes like bullous disease of hemodialysis, calciphylaxis, calcinosis cutis and nephrogenic systemic fibrosis were not observed. None of the cutaneous manifestation's correlation with parathyriod hormone levels was statistically significant. The parathyroid hormone levels were consistently low among the patients who were undergoing hemodialysis between 6 months to 36 months. It was statistically significant. (p=0.037) Conclusion The cutaneous manifestations seen in patients of chronic kidney disease stage 5 undergoing hemodialysis do not seem to have any correlation with parathyroid hormone levels. Thus parathyroid hormone cannot be used as a marker for cutaneous manifestations seen in these patients. Most of the conditions seen in the study were non-specific like pruritus, xerosis and pallor. Among the specific manifestations only acquired perforating dermatosis was seen. This too was seen in only 3 (4.7%) patients. It did not have any statistically positive correlation with parathyroid hormone levels. Perhaps the bicarbonate diasylate has properties to filter calcium salts and porphyrins due to which neither calcific disorders nor bullous changes were seen. Otherwise the other specific manifestations may be more relevant to western population.