International Urology and Nephrology

, Volume 49, Issue 9, pp 1673–1679 | Cite as

Insomnia, muscular cramps and pruritus have low intensity in hemodialysis patients with good dialysis efficiency, low inflammation and arteriovenous fistula

  • Olga Hilda Orasan
  • Aniela Pop Saplontai
  • Angela Cozma
  • Simona Racasan
  • Ina Maria Kacso
  • Crina Claudia Rusu
  • Diana Moldovan
  • Dacian Tirinescu
  • Alina Potra
  • Ioan Mihai Patiu
  • Remus Aurel Orasan
Nephrology - Original Paper
  • 103 Downloads

Abstract

Introduction

Insomnia, muscular cramps, pruritus and postdialysis recovery time (RT) are quality-of-life parameters that affect hemodialysis (HD) patients physically and mentally.

Methods

We included 171 end-stage renal disease patients: 115 on high-flux HD and 56 on online hemodiafiltration (HDF). Patients were asked “How long does it take you to recover from a dialysis session?” and they evaluated intensity (absent, mild, medium and severe) of insomnia, muscular cramps and pruritus in the past 4 weeks. We sought associations of RT, insomnia, muscular cramps and pruritus with themselves and age, dialysis vintage, sex, body mass index, hemoglobin, albumin, C-reactive protein (CRP), Daugirdas single-pool Kt/V (Kt/V), ultrafiltration volume, blood processed volume and vascular access type.

Results

Insomnia absence correlated with muscular cramps absence (p = 0.01), arteriovenous fistula (AVF) presence (p = 0.02) and lower CRP (p = 0.003). Muscular cramps absence associated pruritus absence (p = 0.007) and AVF (p = 0.001). Absent pruritus patients were younger (p = 0.04), had higher Kt/V (p = 0.01) and more AVF (p = 0.02). Men insomnia was more severe in HD than HDF and albumin related (p = 0.007), while CRP was lower in absent pruritus. Women insomnia associated with muscular cramps (p = 0.04) and vascular access (p = 0.03), as was pruritus (p = 0.03). RT had no relations with any parameter.

Conclusions

HD patients with AVF have less insomnia, muscular cramps and pruritus. Insomnia is associated with muscular cramps and inflammation. Pruritus is worse in older patients, is diminished with increased dialysis efficiency and is associated with higher CRP in men. There is no difference between HD and HDF patients, except more severe insomnia for HD in men.

Keywords

Insomnia Muscular cramps Pruritus Posthemodialysis recovery time Hemodialysis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Fukuhara S, Lopes AA, Bragg-Gresham JL, Kurokawa K, Mapes DL, Akizawa T, Bommer J, Canaud BJ, Port FK, Held PJ, Worldwide Dialysis Outcomes and Practice Patterns Study (2003) Health-related quality of life among dialysis patients on three continents: the Dialysis Outcomes and Practice Patterns Study. Kidney Int 64(5):1903–1910CrossRefPubMedGoogle Scholar
  2. 2.
    Mapes DL, Lopes AA, Satayathum S, McCullough KP, Goodkin DA, Locatelli F, Fukuhara S, Young EW, Kurokawa K, Saito A, Bommer J, Wolfe RA, Held PJ, Port FK (2003) Health-related quality of life as a predictor of mortality and hospitalization: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int 64(1):339–349CrossRefPubMedGoogle Scholar
  3. 3.
    Hayashino Y, Fukuhara S, Akiba T, Akizawa T, Asano Y, Saito S, Kurokawa K (2009) Low health-related quality of life is associated with all-cause mortality in patients with diabetes on haemodialysis: the Japan Dialysis Outcomes and Practice Patterns Study. Diabet Med 26(9):921–927. doi: 10.1111/j.1464-5491.2009.02800.x CrossRefPubMedGoogle Scholar
  4. 4.
    Lindner AV, Novak M, Bohra M, Mucsi I (2015) Insomnia in patients with chronic kidney disease. Semin Nephrol 35(4):359–372. doi: 10.1016/j.semnephrol.2015.06.007 CrossRefPubMedGoogle Scholar
  5. 5.
    Rayner HC, Zepel L, Fuller DS, Morgenstern H, Karaboyas A, Culleton BF, Mapes DL, Lopes AA, Gillespie BW, Hasegawa T, Saran R, Tentori F, Hecking M, Pisoni RL, Robinson BM (2014) Recovery time, quality of life, and mortality in hemaodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 64(1):86–94. doi: 10.1053/j.ajkd.2014.01.014 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Pisoni RL, Wikstrom B, Elder SJ, Akizawa T, Asano Y, KeenML Saran R, Mendelssohn DC, Young EW, Port FK (2006) Pruritus in haemodialysis patients: international results from Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 21(12):3495–3505CrossRefPubMedGoogle Scholar
  7. 7.
    Weisshaar E (2016) Epidemiology of uraemic itch: new data. Eur J Pain 20(1):32–36. doi: 10.1002/ejp.761 CrossRefPubMedGoogle Scholar
  8. 8.
    Afsar B, Elsurer R, Covic A, Kanbay M (2012) Vascular access type, health-related quality of life, and depression in hemodialysis patients: a preliminary report. J Vasc Access 13(2):215–220. doi: 10.5301/jva.5000032 CrossRefPubMedGoogle Scholar
  9. 9.
    Moura A, Madureira J, Alija P, Fernandes JC, Oliveira JG, Lopez M, Filgueiras M, Arnado L, Sameiro-Faria M, Miranda V, Vieira M, Santos-Silva A, Costa E (2014) Type of vascular access and location in online hemodiafiltration and its association with patient’s perception of health-related quality of life. J Vasc Access 15(3):175–182. doi: 10.5301/jva.5000182 CrossRefPubMedGoogle Scholar
  10. 10.
    Novak M, Shapiro CM, Mendelssohn D, Mucsi I (2006) Diagnosis and management of insomnia in dialysis patients. Semin Dial 19:25–31. doi: 10.1111/j.1525-139X.2006.00116.x CrossRefPubMedGoogle Scholar
  11. 11.
    Razeghi E, Sahraian MA, Heidari R, Bagherzadeh M (2012) Association of inflammatory biomarkers with sleep disorders in hemodialysis patients. Acta Neurol Belg 112(1):45–49. doi: 10.1007/s13760-012-0003-7 CrossRefPubMedGoogle Scholar
  12. 12.
    Bornivelli C, Alivanis P, Giannikouris I, Arvanitis A, Choustoulakis I, Georgopoulou K, Karvouniaris N, Zervos A (2008) Relation between insomnia mood disorders and clinical and biochemical parameters in patients undergoing chronic hemodialysis. J Nephrol 21(Suppl 13):S78–S83PubMedGoogle Scholar
  13. 13.
    Knezevis MZ, Djordjevic VV, Jankovic SM, Djordjevic VM (2013) Influence of dialysis modality and membrane flux on insomnia severity in haemodialysis patients. Nephrology (Carlton) 18(11):706–711. doi: 10.1111/nep.12131 CrossRefGoogle Scholar
  14. 14.
    Orasan RA, Patiu IM, Anghel D, Bejan C, Iosub L, Totolici C, Pop M, Turcea C, Teodoru C, Orasan OH, Kacso IM, Gherman Caprioara M (2013) Variation of clinical and laboratory features in chronic dialysis patients treated with high-flux hemodialysis after switching to online hemodiafiltration. Int Urol Nephrol 45(5):1415–1422. doi: 10.1007/s11255-012-0341-7 CrossRefPubMedGoogle Scholar
  15. 15.
    Noordzij M, Boeschoten EW, Bos WJ, Dekker FW, Bossuyt PM, Krefiet RT, Korevaar JC, NECOSAD Study Group (2007) Disturbed mineral metabolism is associated with muscle and skin complaints in a prospective cohort of dialysis patients. Nephrol Dial Transplant 22(10):2944–2949CrossRefPubMedGoogle Scholar
  16. 16.
    Combs SA, Teixeira JP, Germain MJ (2015) Pruritus in kidney disease. Semin Nephrol 35(4):383–391. doi: 10.1016/j.semnephrol.2015.06.009 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Melo NC, Elias RM, Castro MC, Romao JE Jr, Abensur H (2009) Pruritus in hemodialysis patients: the problem remains. Hemdial Int 13(1):38–42. doi: 10.1111/j.1542-4758.2009.00346.x CrossRefGoogle Scholar
  18. 18.
    Ko MJ, Wu HY, Chen HY, Chiu YL, Hsu SP, Pai MF, Ju-Yehyang Lai CF, Lu HM, Huang SC, Yang SY, Wen SY, Chiu HC, Hu FC, Peng YS, Jee SH (2013) Uremic pruritus, dialysis adequacy, and metabolic profiles in hemodialysis patients: a prospective 5-year cohort study. PLoS ONE 8(8):e71404. doi: 10.1371/journal.pone.0071404 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Duque MI, Thevarajah S, Chan YH, Tuttle AB, Freedman BI, Yosipovitch G (2006) Uremic pruritus is associated with higher kt/V and serum calcium concentration. Clin Nephrol 66(3):184–191CrossRefPubMedGoogle Scholar
  20. 20.
    Weiss M, Mettang T, Tschulena U, Weisshaar E (2016) Health-related quality of life in haemodialysis patients suffering from chronic itch: results from GEHIS (German Epidemiology Haemodialysis Itch Study). Qual Life Res 25(12):3097–3106CrossRefPubMedGoogle Scholar
  21. 21.
    Smith JR, Zimmer N, Bell E, Francq BG, McConnachie A, Mactier R (2016) A randomized, single-blind, crossover trial of recovery time in high-flux hemodialysis and hemodiafiltration. Am J Kidney Dis 23:pii: S0272-6386(16)30635-7. doi: 10.1053/j.ajkd.2016.10.025 Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Olga Hilda Orasan
    • 1
  • Aniela Pop Saplontai
    • 2
  • Angela Cozma
    • 1
  • Simona Racasan
    • 3
  • Ina Maria Kacso
    • 4
  • Crina Claudia Rusu
    • 4
  • Diana Moldovan
    • 4
  • Dacian Tirinescu
    • 4
  • Alina Potra
    • 4
  • Ioan Mihai Patiu
    • 3
  • Remus Aurel Orasan
    • 3
  1. 1.4th Medical DepartmentUniversity of Medicine and Pharmacy “Iuliu Hatieganu”Cluj-NapocaRomania
  2. 2.5th Medical DepartmentUniversity of Medicine and Pharmacy “Iuliu Hatieganu”Cluj-NapocaRomania
  3. 3.Nefromed Dialysis CenterCluj-NapocaRomania
  4. 4.Department of NephrologyUniversity of Medicine and Pharmacy “Iuliu Hatieganu”Cluj-NapocaRomania

Personalised recommendations