Effect of Acupressure on Severity and Outcome of Uremic Pruritus in Hemodialysis Patients: A Randomized Clinical Trial

Authors

DOI:

https://doi.org/10.22100/sjms.v11i2.1183

Keywords:

Acupressure, Uremic Pruritus, Hemodialysis

Abstract

Introduction: One of the troublesome problems of patients in the end stages of renal disease (ESRD) is uremic pruritus (UP), which can adversely affect the quality of life, treatment process, and longevity of patients. The present study investigated the effect of acupressure on the severity and outcome of UP in hemodialysis patients.

Methods: In this study's three-group randomized controlled clinical trial, 105 patients undergoing hemodialysis were selected by convenience sampling. Patients were randomly assigned to acupressure (n=35), sham (n=35), and control (n=35) groups. The acupressure group received acupressure in SP 6, SP 10, ST 36, and L I11 points, while the sham group received acupressure in non-real points. The severity and outcome of  UP were evaluated before, 4, and 12 weeks after the intervention using a Visual Analog Scale (VAS) and a 5-D itch scale, respectively. Finally, data collected from 105 participants were analyzed using SPSS version 25 software. Kruskal Wallis and Friedman tests were used to compare the severity and outcome of  UP between and within groups, respectively.  

Result: UP's severity and outcome after the intervention significantly improved in the acupressure group compared to the other two groups (p<0.05).

Conclusion: The use of acupressure can improve the severity and outcome of  UP  in hemodialysis patients and training this method to nurses and patients is recommended as a safe and accessible way to heal their pruritus.

References

Torkmannejad Sabzevari M, Khalili H, Rad M. Non-Pharmacological Treatments of Pruritus in Hemodialysis Patients: A Review Study. Jundishapur Journal of Chronic Disease Care. 2018;7(2):e67794. doi: 10.5812/jjcdc.67794

Hu T, Wang B, Liao X, Wang S. Clinical features and risk factors of pruritus in patients with chronic renal failure. Experimental and therapeutic medicine. 2019;18(2):964-971. doi: 10.3892/etm.2019.7588

Shirazian S, Aina O, Park Y, et al. Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges. International journal of nephrology and renovascular disease. 2017:11-26. doi: 10.2147/IJNRD.S108045

Westby EP, Purdy KS, Tennankore KK. A review of the management of uremic pruritus: current perspectives and future directions. Itch. 2020;5 (3). doi: 10.1097/itx.0000000000000038

Rehman IU, Lai PS, Kun LS, Lee LH, Chan KG, Khan TM. Chronic kidney disease‐associated pruritus and quality of life in Malaysian patients undergoing hemodialysis. Therapeutic Apheresis and Dialysis. 2020;24(1):17-25. doi: 10.1111/1744-9987.12862

Pisoni RL, Wikström B, Elder SJ, et al. Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrology Dialysis Transplantation. 2006;21(12):3495-3505. doi: 10.1093/ndt/gfl461

Panma Y, Yetti, K., & Sukmarini, L. (2021). Application of Acupressure in Reducing Pruritus Scale in Hemodialysis Patients. KnE Life Sciences, 371-382.‏ doi: 10.18502/kls.v6i1.8627

Suzuki H, Omata H, Kumagai H. Recent advances in treatment for uremic pruritus. Open Journal of Nephrology. 2015;5(01):1. doi: 10.4236/ojneph.2015.51001

Karjalian F, Momennasab M, Yoosefinejad AK, Jahromi SE. The Effect of Acupressure on the Severity of Pruritus and Laboratory Parameters in Patients Undergoing Hemodialysis: A Randomized Clinical Trial. Journal of Acupuncture and Meridian Studies. 2020;13(4):117-123. doi: 10.1016/j.jams.2020.05.002

Farrokhi F AN, Beyene J, Kurdyak P, Jassal SV. Association between depression and mortality in patients receiving long-term dialysis: a systematic review and meta-analysis. American journal of kidney diseases. 2014;63(4):623-35. doi: 10.1053/j.ajkd.2013.08.024

Nahidi Y, Badiee S, Torabi S, Shaye ZA, Nazemian F, Saki A. Acupuncture effect on pruritus in hemodialysis patients: A randomized clinical trial. Iranian Red Crescent Medical Journal. 2018;20(10):e65521. doi: 10.5812/ircmj.65521

National KF. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation c, and stratification. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2002;39(2 Suppl 1):S1.

Dehbashi F SS, Tirgari B. The relationship between spiritual well-being and hope in Hemodialysis patients referring to the Khatam Anbiya hospital in Zahedan 2013-2014. Medical Ethics Journal. 2015;9(30):77-97.

Panma Y, Yetti K, Sukmarini L. Application of Acupressure in Reducing Pruritus Scale in Hemodialysis Patients. KnE Life Sciences. 2021 371-82. doi: 10.18502/kls.v6i1.8627

Kılıç Akça N TS, Karataş N. Effect of acupressure on patients in Turkey receiving hemodialysis treatment for uremic pruritus. Alternative Therapies in Health & Medicine. 2013;19 (5).

Akça N, Taşcı S. Acupressure and Transcutaneous Electrical Acupoint Stimulation for Improving Uremic Pruritus: A Randomized, Controlled Trial. Alternative Therapies in Health & Medicine. 2016;22(3):18-24.

Batvani M, Yousefi, H., Valiani, M., Shahabi, J., & Mardanparvar, H. (2018). The Effect of Acupressure on Physiological Parameters of Myocardial Infarction Patients: A Randomized Clinical Trial. Iranian journal of nursing and midwifery research, 23(2), 143-148. doi: 10.4103/ijnmr.IJNMR_83_16

Panma Y, Yetti K, Sukmarini L. Application of Acupressure in Reducing Pruritus Scale in Hemodialysis Patients. presented at: The 4th International Virtual Conference on Nursing; 2021; doi: 10.18502/kls.v6i1.8627

Che-Yi C, Wen C, Min-Tsung K, Chiu-Ching H. Acupuncture in haemodialysis patients at the Quchi (LI11) acupoint for refractory uraemic pruritus. Nephrology Dialysis Transplantation. 2005;20(9):1912-5. doi: 10.1093/ndt/gfh955

Badiee Aval S, Ravanshad Y, Azarfar A, Mehrad-Majd H, Torabi S, Ravanshad S. A systematic review and meta-analysis of using acupuncture and acupressure for uremic pruritus. Iranian journal of kidney diseases. 2018;12(2):78.

Che-Yi C WC, Min-Tsung K, Chiu-Ching H. Acupuncture in haemodialysis patients at the Quchi (LI11) acupoint for refractory uraemic pruritus. Nephrology Dialysis Transplantation. 2005;20(9):1912-5. doi: 10.1093/ndt/gfh955

Kim KY, Kim JSTW, Tsai AWW, Hsing WT. Acupuncture for the treatment of itch: literature review and future perspectives. Medical Acupuncture. 2021;33(2):137-143. doi: 10.1089/acu.2020.1445

Kim J SW. How to do random allocation (randomization). Clinics in orthopedic surgery. 2014;6(1):103-9. doi: 10.4055/cios.2014.6.1.103

Reich A, Heisig M, Phan NQ, et al. Visual analogue scale: evaluation of the instrument for the assessment of pruritus. Acta Dermato Venereologica. 2012;92(5):497-501. doi: 10.2340/00015555-1265

Zhao J-H, Zhu Q-S, Li Y-W, Wang L-L. Determinants of the intensity of uremic pruritus in patients receiving maintenance hemodialysis: a cross-sectional study. PloS one. 2021;16(1):e0245370. doi: 10.1371/journal.pone.0245370

Elman S HL, Gabriel V, Mayo MJ. The 5-D itch scale: a new measure of pruritus. Br J Dermatol. 2010 Mar;162(3):587-93. doi: 10.1111/j.1365-2133.2009.09586.x

Yoosefinejad AK, Karjalian, F., Momennasab, M. et al. Reliability and validity of the Persian version of 5-D itching scale among patients with chronic kidney disease. BMC Nephrol 22, 16 (2021). doi: 10.1186/s12882-020-02220-x

Schlaeger J, Gabzdyl E, Bussell J, et al. Acupuncture and Acupressure in Labor. J Midwifery Womens Health 2017;62(1):12-28. doi: 10.1111/jmwh.12545

Smith C, Collins C, Levett K, et al. Acupuncture or acupressure for pain management during labour. Cochrane Database Syst Rev. 2020 2(2):CD009232. doi: 10.1002/14651858.CD009232.pub2

Arab Z, Shariati A, Asayesh H, Vakili M, Bahrami-Taghanaki H, Azizi H. Sham-controlled trial of acupressure on the quality of sleep and life in haemodialysis patients. Acupunct Med. 2016 34(1):2-6. doi: 10.1136/acupmed-2014-010369

Yan J, An Y, Wang L-s, Li Y, Yang S. Acupoint stimulation for chronic urticaria: a systematic review of randomized controlled trials. European Journal of Integrative Medicine. 2015;7(6):586-592. doi: 10.1016/j.eujim.2015.09.007

Kang M, Kim YK. Effects of acupressure on pruritus and sleep in patients on hemodialysis. Journal of Korean Academy of Fundamentals of Nursing. 2017;24(1):9-17. doi: 10.7739/jkafn.2017.24.1.9

Lin H, Liu Y, Liu J, et al. Uremic pruritus, cytokines, and polymethylmethacrylate artificial kidney. Artif Organs. 2008 32(6):468-72. doi: 10.1111/j.1525-1594.2008.00568.x

Yan CN, Yao WG, Bao YJ, et al. Effect of auricular acupressure on uremic pruritus in patients receiving hemodialysis treatment: a randomized controlled trial Evidence-Based Complementary and Alternative Medicine. 2015;2015 (593196) doi: 10.1155/2015/593196

Zucker I YG, David M, Gafter U, Boner G. Prevalence and characterization of uremic pruritus in patients undergoing hemodialysis: uremic pruritus is still a major problem for patients with end-stage renal disease. Journal of the American Academy of Dermatology. 2003;49(5):842-6. doi: 10.1016/S0190-9622(03)02478-2

Zhang D, Ding G, Shen X, et al. Influence of mast cell function on the analgesic effect of acupuncture of "Zusanli" (ST 36) in rats]. . ;32(3):147-52. Chinese. PMID: 17691569. Zhen Ci Yan Jiu. 2007;

Senna-Fernandes V, França, D. L., Santos, K. C., Sousa, R. S., Silva, D., Cortez, C. M., ... & Guimarães, M. A. (2009). Effect of Zusanli (ST. 36) Electroacupuncture at Two Frequencies on the Bioavailability of 99mTc-Sodium Pertechnetate and on Labeling of Blood Constituents in Rats. Journal of Acupuncture and Meridian Studies, 2(2), 135-146.‏. doi: 10.1016/S2005-2901(09)60046-7

Makhlough A EN, Sedighi O, Khademloo M, Bicmohamadi AR. Relationship between serum intact parathyroid hormone and pruritus in hemodialysis patients. Iran J Kidney Dis. 2013 Jan;7(1):42-6. PMID: 23314141.

Tajbakhsh R, Joshaghani, H. R., Bayzayi, F., Haddad, M., & Qorbani, M. (2013). Association between pruritus and serum concentrations of parathormone, calcium, and phosphorus in hemodialysis patients. Saudi Journal of Kidney Diseases and Transplantation, 24(4), 702.‏. doi: 10.4103/1319-2442.113858

Wei Y, Dong M, Zhong L, Liu J, Luo Q, Lv Y, Mo S, Sun J, Liu F, Xu F, Yan C, Dong J. (2017). Regulation of hypothalamic-pituitary-adrenal axis activity and immunologic function contributed to the anti-inflammatory effect of acupuncture in the OVA-induced murine asthma model. Neurosci Lett. 1;636:177-183. doi: 10.1016/j.neulet.2016.11.001

Li N, Guo Y, Gong Y, Zhang Y, Fan W, Yao K, Chen Z, Dou B, Lin X, Chen B, Chen Z. (2021). The anti-inflammatory actions and mechanisms of acupuncture from acupoint to target organs via neuro-immune regulation. Journal of inflammation research. 21:7191-224. doi: 10.2147/JIR.S341581

Mettang T, E.Kremer A. Uremic pruritus. 2015;87(4):685-691. doi: 10.1038/ki.2013.454

Altınok Ersoy N, Akyar İ. Multidimensional pruritus assessment in hemodialysis patients. BMC Nephrol. . 2019 Feb 20(1):42. doi: 10.1186/s12882-019-1234-0

Weng C, Hu C, Yen T, Hsu C, Huang W. Uremic Pruritus is Associated with Two-Year Cardiovascular Mortality in Long Term Hemodialysis Patients. Kidney Blood Press Res.2018, 43(3), 1000-1009. doi: 10.1159/000490689

Trachtenberg AJa, Collister D, Rigatto C, b. Recent advances in the treatment of uremic pruritus. Current Opinion in Nephrology and Hypertension. 2020;29(5):465-470 doi: 10.1097/MNH.0000000000000625

Campbell P, Moss J, Mulder M, et al. The effectiveness of complementary and alternative medicine in the symptom management of pruritus in patients with end-stage kidney disease: a systematic review. Renal Society of Australasia Journal. 2020;16(2):58-68. doi: 10.33235/rsaj.16.2.58-68

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Published

2025-07-22

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Vol. 11 No. 2 (2025)

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Effect of Acupressure on Severity and Outcome of Uremic Pruritus in Hemodialysis Patients: A Randomized Clinical Trial. (2025). Shahroud Journal of Medical Sciences, 11(2), 47-56. https://doi.org/10.22100/sjms.v11i2.1183