Dermatological Manifestations Among Patients on Maintenance Hemodialysis

Akram Beheshti, MD; Malihe Charkhchian, MD; Amir Abdollah Zangivand, MD; Afsaneh Sedighi, MD; Golnoosh Amri, MD


Wounds. 2013;25(3):61-67. 

In This Article

Abstract and Introduction


Introduction. Patients with chronic kidney disease on hemodialysis (HD) undergo many dermatological signs and symptoms during treatment. The aim of this study was to investigate the prevalence of skin manifestations among the patients on maintenance HD in the HD center of Boo Ali-Sina Hospital (Qazvin, Iran) and compare them with the general population.

Methods. From June 2012 to July 2012 a case-controlled study was performed with 149 patients with end-stage renal disease undergoing regular HD (HD group) and 150 individuals who were randomly selected (control group) from healthy hospital staff at Boo Ali-Sina Hospital. A dermatologist examined all individuals in both groups to assess of skin, hair, nail, and mucosal tissues.

Results. Overall, 108 of the patients in the HD group and 54 of the individuals in the control group were found to have at least 1 cutaneous and mocusal manifestation. Pruritus, skin discoloration, ecchymosis, drying and hair fragility, leukonychia, absent lunula, and half and half nails were more frequent in the HD group than compared to the control group (P < 0.05). Although no significant correlation between dermatological manifestations and age ≥ 65 or diabetes mellitus were made, multiple logistic regression analysis indicated that male sex, hypertension, and long-term HD were associated with dermatological manifestations.

Discussion. In the present study, cutaneous and mocusal manifestations ranged from 36% in the control group to 72.4% in the HD group. The results also indicate a relationship between cutaneous and mocusal manifestations, and male sex, hypertension, and duration of dialysis in HD patients.


Chronic kidney disease (CKD), also known as chronic renal failure (CRF), is a progressive loss of renal function over a period of months or years.[1,2] Chronic kidney disease is divided into 5 stages of increasing severity. Each stage is a progression through an abnormally decreasing and deteriorating glomerular filtration rate (GFR), which is usually determined indirectly by the serum creatinine level.[1,2] All individuals with either kidney damage or a GFR < 60 ml/min/1.73 m2 for 3 months are classified as having chronic renal disease.[1,2] End-stage renal disease (ESRD) is considered the fifth stage of CKD, and can lead to uremic syndrome, which can cause death in patients with this condition if toxins accumulate in the body.[3]

Patients with CKD on hemodialysis (HD) experience many dermatological symptoms during treatment. Since these symptoms are only detected in advanced cases of the disease, they are not valuable in the diagnosis of kidney failure.[4] Complete and precise examination of skin, hair, nails, and mucosal membranes may reveal a wide variety of the following symptoms including hyperpigmentation, xerosis, ichthyosis, pruritus, onychomycosis, onycholysis, splinter hemorrhages, subungual hyperkeratosis, brittle hair, and sparse body scalp hair.[5–8]

These diseases are sometimes related to underlying renal illness but are more often associated, directly or indirectly, with uremia in its broadest sense.

With a nearly 100% prevalence in dialysis populations, skin disorders are frequently the subject of patients' complaints.[6] Studies from different regions of the world have revealed different cutaneous manifestations in patients on HD.[6,9–11] However, few of these were controlled studies conducted to compare the prevalence of these disorders in patients undergoing dialysis with healthy individuals in the general population.[12,13] Therefore, in the present study the aim was to compare the prevalence of skin manifestations among patients on maintenance HD in Boo Ali-Sina Hospital, Qazvin, Iran, to the general population of the city.