Effect of Auricular Acupressure on Uremic Pruritus in Patients Receiving Hemodialysis Treatment: A Randomized Controlled Trial

Cui-Na Yan, Wei-Guo Yao, Yi-Jie Bao, Xiao-Jing Shi, Hui Yu, Pei-Hao Yin, Gui-Zhen Liu, Cui-Na Yan, Wei-Guo Yao, Yi-Jie Bao, Xiao-Jing Shi, Hui Yu, Pei-Hao Yin, Gui-Zhen Liu

Abstract

Background. Uremic pruritus (UP) is a common symptom in patients undergoing maintenance hemodialysis for end-stage renal disease (ESRD). Objective. To determine the clinical efficacy of auricular acupressure therapy on pruritus in hemodialysis patients and to explore possible underlying mechanisms. Methods. Patients receiving maintenance hemodialysis at a referral medical center were recruited and assigned to intervention (n = 32) and control (n = 30) groups. The intervention group underwent auricular acupressure treatment three times a week for six weeks. Auricular acupressure was not applied to patients in the control group. However, tape without Vaccaria seeds was applied to the same six auricular acupoints as the intervention group. Pruritus scores were assessed using VAS scores, and enzyme-linked immunosorbent assays (ELISA) were used to measure levels of other possible contributory biochemical factors. Results. There was a significant difference in mean VAS scores between the postintervention and control groups during follow-up (3.844 ± 1.687 versus 5.567 ± 2.285, F = 22.32, P < 0.0001). Compared to the control group, serum histamine levels in the postintervention group at the six-week follow-up had decreased significantly (F = 5.01, P = 0.0290). Conclusion. Our findings suggest that auricular acupressure may be a useful treatment in the multidisciplinary management of UP in ESRD patients.

Figures

Figure 1
Figure 1
Participant screening, randomization, and completion in the six-week intervention study.
Figure 2
Figure 2
Location of auricular acupoints used in the auricular acupressure treatment group; a: the “kidney”: the back of the bottom ear helix (i.e., the concha 10 region, CO10); b: the “lung”: adjacent to the area of the “heart” and the “trachea” (i.e., the concha 14 region, CO14); c: the “heart”: in the middle ear cavity depression (i.e., the concha 15 region, CO15); d: the “Shenmen”: in the upper part of the posterior 1/3 of the triangular fossa (i.e., the triangular fossa 4 region, TF4); e: the “endocrine”: within the intertragic notch in the lower front concha (i.e., the concha 18 region, CO18); f: the “subcortical”: within the inner side of the tragus (i.e., the tragus 4 region, AT4).
Figure 3
Figure 3
Mean change in visual analog scale (VAS) scores after six weeks, according to the postintervention group. Participant visual analog scale (VAS) scores indicate pruritus intensity and severity: 0 means no pruritus and 10 means very intense pruritus. ∗∗∗P < 0.001 versus control group.
Figure 4
Figure 4
Mean change of serum histamine levels after six weeks, according to the postintervention group. ∗P < 0.05 versus control group.
Figure 5
Figure 5
Mean changes in six secondary outcomes after six weeks, according to the postintervention group; P > 0.05 for postintervention group versus control group.

References

    1. Mathur V. S., Lindberg J., Germain M., et al. A longitudinal study of uremic pruritus in hemodialysis patients. Clinical Journal of the American Society of Nephrology. 2010;5(8):1410–1419. doi: 10.2215/CJN.00100110.
    1. Feramisco J. D., Berger T. G., Steinhoff M. Innovative management of pruritus. Dermatologic Clinics. 2010;28(3):467–478. doi: 10.1016/j.det.2010.03.004.
    1. Mettang M., Weisshaar E. Pruritus: control of itch in patients undergoing dialysis. Skin Therapy Letter. 2010;15(2):1–5.
    1. Wang T.-J., Lan L.-C., Lu C.-S., et al. Efficacy of narrowband ultraviolet phototherapy on renal pruritus. Journal of Clinical Nursing. 2014;23(11-12):1593–1602. doi: 10.1111/jocn.12252.
    1. Chen H.-Y., Chiu Y.-L., Hsu S.-P., et al. Elevated C-reactive protein level in hemodialysis patients with moderate/severe uremic pruritus: a potential mediator of high overall mortality. QJM. 2010;103(11):837–846. doi: 10.1093/qjmed/hcq036.hcq036
    1. Aoki R., Kawamura T., Goshima F., et al. Mast cells play a key role in host defense against herpes simplex virus infection through TNF-α and IL-6 production. Journal of Investigative Dermatology. 2013;133(9):2170–2179. doi: 10.1038/jid.2013.150.
    1. Pakfetrat M., Basiri F., Malekmakan L., Roozbeh J. Effects of turmeric on uremic pruritus in end stage renal disease patients: a double-blind randomized clinical trial. Journal of Nephrology. 2014;27(2):203–207. doi: 10.1007/s40620-014-0039-2.
    1. Ko M.-J., Yang J.-Y., Wu H.-Y., et al. Narrowband ultraviolet B phototherapy for patients with refractory uraemic pruritus: a randomized controlled trial. British Journal of Dermatology. 2011;165(3):633–639. doi: 10.1111/j.1365-2133.2011.10448.x.
    1. Marquez D., Ramonda C., Lauxmann J. E., et al. Uremic pruritus in hemodialysis patients: treatment with desloratidine versus gabapentin. Jornal Brasileiro de Nefrologia. 2012;34(2):148–152.
    1. Akça N. K., Taşçi S., Karataş N. Effect of acupressure on patients in Turkey receiving hemodialysis treatment for uremic pruritus. Alternative Therapies in Health and Medicine. 2013;19(5):12–18.
    1. Han J., Bai B. Effect of auricular acupressure on constipation patient. Guangmingzhongyi. 2014;29:337–338.
    1. Furue M., Ebata T., Ikoma A., et al. Verbalizing extremes of the visual analogue scale for pruritus: a consensus statement. Acta Dermato-Venereologica. 2013;93(2):214–215. doi: 10.2340/00015555-1446.
    1. Narita I., Iguchi S., Omori K., Gejyo F. Uremic pruritus in chronic hemodialysis patients. Journal of Nephrology. 2008;21(2):161–165.
    1. Stellon A. The use of laser acupuncture for the treatment of neurogenic pruritus in a child—a case history. Acupuncture in Medicine. 2005;23(1):31–33. doi: 10.1136/aim.23.1.31.
    1. Pfab F., Huss-Marp J., Gatti A., et al. Influence of acupuncture on type i hypersensitivity itch and the wheal and flare response in adults with atopic eczema—a blinded, randomized, placebo-controlled, crossover trial. Allergy. 2010;65(7):903–910. doi: 10.1111/j.1398-9995.2009.02284.x.
    1. Jin H.-P., Wu Q.-Y., Zhang W., Xie J.-J., Chen J.-C. Post-stroke dysphagia in chronic stage treated with magnetic-ball sticking therapy at the auricular points: a randomized controlled trial. Zhongguo Zhen Jiu. 2014;34(1):9–14.
    1. Kim D., Ham O. K., Kang C., Jun E. Effects of auricular acupressure using Sinapsis alba seeds on obesity and self-efficacy in female college students. The Journal of Alternative and Complementary Medicine. 2014;20(4):258–264. doi: 10.1089/acm.2012.0283.
    1. Cheng G., Cheng W., Jiang Y.-G. Controlled observation of clinical efficacy on knee osteoarthritis treated with auricular electroacupuncture and the isolated moxibustion with Lingxian herbal paste. Zhongguo Zhen Jiu. 2014;34(3):230–234.
    1. Che-Yi C., Wen C. Y., Min-Tsung K., Huang C.-C. Acupuncture in haemodialysis patients at the Quchi (LI11) acupoint for refractory uraemic pruritus. Nephrology Dialysis Transplantation. 2005;20(9):1912–1915. doi: 10.1093/ndt/gfh955.
    1. Berger T. G., Steinhoff M. Pruritus and renal failure. Seminars in Cutaneous Medicine and Surgery. 2011;30(2):99–100. doi: 10.1016/j.sder.2011.04.005.
    1. Fallahzadeh M. K., Roozbeh J., Geramizadeh B., Namazi M. R. Interleukin-2 serum levels are elevated in patients with uremic pruritus: a novel finding with practical implications. Nephrology Dialysis Transplantation. 2011;26(10):3338–3344. doi: 10.1093/ndt/gfr053.
    1. Ko M. J., Peng Y. S., Chen H. Y., et al. Interleukin-31 is associated with uremic pruritus in patients receiving hemodialysis. Journal of the American Academy of Dermatology. 2014;71:1151–1159.
    1. Dugas-Breit S., Schöpf P., Dugas M., Schiffl H., Ruëff F., Przybilla B. Baseline serum levels of mast cell tryptase are raised in hemodialysis patients and associated with severity of pruritus. Journal der Deutschen Dermatologischen Gesellschaft. 2005;3(5):343–347. doi: 10.1111/j.1610-0387.2005.05706.x.
    1. Kanda N., Watanabe S. Histamine enhances the production of nerve growth factor in human keratinocytes. Journal of Investigative Dermatology. 2003;121(3):570–577. doi: 10.1046/j.1523-1747.2003.12428.x.
    1. Kremer A. E., Feramisco J., Reeh P. W., Beuers U., Oude Elferink R. P. J. Receptors, cells and circuits involved in pruritus of systemic disorders. Biochimica et Biophysica Acta. 2014;1842(7):869–892. doi: 10.1016/j.bbadis.2014.02.007.
    1. Manni L., Albanesi M., Guaragna M., Barbaro Paparo S., Aloe L. Neurotrophins and acupuncture. Autonomic Neuroscience: Basic and Clinical. 2010;157(1-2):9–17. doi: 10.1016/j.autneu.2010.03.020.
    1. Zhang D., Ding G., Shen X., et al. The impact of mast cell function on analgesic effect of ‘Zusanli’. Acupuncture Research. 2007;32:47–152.
    1. Zheng C., Huang G., Zhang M. The expression of dual-labeled fluorescent Cx43 on ‘Zusanli’ study of rat. Acupuncture Research. 2005;30:221–224.
    1. Junna H., Mingfu L., Ying G., et al. Relationship between mast cells and treatment efficacy of gastric ulcer on rat by body acupuncture and auricular acupuncture. Acupuncture Research. 2008;33:159–163.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner