Acupuncture for Uremic Pruritus: A Systematic Review and Meta-Analysis


      Uremic pruritus (UP) is a chronic disease that can seriously affect the quality of life of dialysis patients. Acupuncture is a non-medication therapy that has been used to treat pruritus disorders. This systematic review aimed to evaluate the efficacy and safety of acupuncture for the treatment of UP. A total of nine Chinese and English databases were searched from their inception to December 31, 2021, and 214 studies were retrieved. Finally, seven randomized controlled trials (n=504) were included in the meta-analysis performed using RevMan V.5.3. Results included effective rate, recurrence rates, and adverse events. Compared with conventional treatment, acupuncture was more effective in treating UP (risk ratio [RR]=1.28, 95% confidence interval [CI]=1.09 to 1.50, P=0.003). The results were consistent after sensitivity analysis (RR=1.38, 95% CI=1.21 to 1.57, P<0.00001). In subgroup analysis, the efficacy rates of acupuncture and medications (oral and topical) were comparable (RR=1.20, 95% CI=0.98 to 1.47, P=0.07). Acupuncture combined with hemodialysis was more effective than hemodialysis alone in relieving pruritus (RR=1.42, 95% CI=1.18 to 1.72, P=0.0002). Adverse events were reported in only three studies, including one case of hyperphosphatemia in the medications group (RR=0.29, 95% CI=0.01 to 7.06, P=0.45). None of the studies reported recurrence rates. In conclusion, acupuncture is a safe treatment modality for patients with UP receiving hemodialysis that can effectively improve UP symptoms, and acupuncture in combination with hemodialysis has more efficacy than hemodialysis alone in improving the UP symptoms.

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        • Leila M
        • Taraneh T
        • Maryam P
        • Afshin M
        • Neda Z
        Treatments of uremic pruritus: a systematic review.
        Dermatol Ther. 2018; 31: e12683
        • Mettang T
        • Kremer A
        Uremic pruritus.
        Kidney Int. 2015; 87: 685-691
        • Minato S
        • Hirai K
        • Morino J
        • et al.
        Factors associated with uremic pruritus in patients undergoing peritoneal dialysis.
        Int J Nephrol Renovascular Dis. 2020; 13: 1-9
        • Narita I
        • Alchi B
        • Omori K
        • et al.
        Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients.
        Kidney Int. 2006; 69: 1626-1632
        • Mathur V
        • Lindberg J
        • Germain M
        • et al.
        A longitudinal study of uremic pruritus in hemodialysis patients.
        Clin J Am Soc Nephrol. 2010; 5: 1410-1419
        • Wu H
        • Huang J
        • Tsai W
        • et al.
        Prognostic importance and determinants of uremic pruritus in patients receiving peritoneal dialysis: a prospective cohort study.
        PLoS One. 2018; 13e0203474
        • Pisoni RL
        • Bjrn W
        • Elder SJ
        • et al.
        Pruritus in haemodialysis patients: international results from the dialysis outcomes and practice patterns study (DOPPS).
        Nephrol Dial Transplant. 2006; 21: 3495
        • Combs S
        • Teixeira J
        • Germain M
        Pruritus in kidney disease.
        Semin Nephrol. 2015; 35: 383-391
        • Manns B
        • Hemmelgarn B
        • Lillie E
        • Dip S
        • Laupacis A
        Setting research priorities for patients on or nearing dialysis.
        Clin J Am Soc Nephrol. 2014; 9: 1813-1821
        • Hu X
        • Sang Y
        • Yang M
        • Chen X
        • Tang W
        Prevalence of chronic kidney disease-associated pruritus among adult dialysis patients: a meta-analysis of cross-sectional studies.
        Medicine (Baltimore). 2018; 97: e10633
        • Trachtenberg A
        • Collister D
        • Rigatto C
        Recent advances in the treatment of uremic pruritus.
        Curr Opin Nephrol Hypertens. 2020; 29: 465-470
        • Yosipovitch G
        • Duque MI
        • Patel TS
        • et al.
        Skin barrier structure and function and their relationship to pruritus in end-stage renal disease.
        Nephrol Dial Transplant. 2007; 22: 3268-3272
        • Reszke R
        • Szepietowski JC
        End-stage renal disease chronic itch and its management.
        Dermatol Clin. 2018; 36: 277-292
        • JDdS Tinco
        • MdGMNd Paiva
        • Macedo B
        • Cossi MS
        • Lira ALBDC
        Pruritus in hemodialysis patients: association with phosphorus intake and serum calcium level.
        Rev Gaucha Enferm. 2018; 39e20170081
        • Zakrzewska-Pniewska B
        • Jedras M
        Is pruritus in chronic uremic patients related to peripheral somatic and autonomic neuropathy? Study by R-R interval variation test (RRIV) and by sympathetic skin response (SSR).
        Neurophysiol Clin-Clin Neurophysiol. 2001; 31: 181-193
        • Nurten O
        • Ilknur CF
        • Dilek A
        • Dilek M
        Uremic pruritus and associated factors in hemodialysis patients: a multi-center study.
        Kidney Res Clin Pract. 2018; 37: 138-147
        • Garcia GE
        • Ma SX
        • Feng L
        Acupuncture and kidney disease.
        Adv Chronic Kidney Dis. 2005; 12: 282-291
        • Gao H
        • Zhang W
        • Wang Y
        Acupuncture treatment for 34 cases of uremic cutaneous pruritus.
        J Tradit Chin Med. 2002; 22: 29-30
        • Chou CY
        • Yu WC
        • Kao MT
        • Huang CC
        Acupuncture in haemodialysis patients at the Quchi (LI11) acupoint for refractory uraemic pruritus.
        Nephrol Dial Transplant. 2005; 20: 1912-1915
        • Lingling M
        • Peiran Z
        • Ke R
        Clinical study of acupuncture combined with hemoperfusion in the treatment of uremia pruritus (Chinese).
        Mod Chin Med Clin. 2014; 21: 4
        • Chengfu L
        Clinical observation of acupuncture at Quchi and Xuehai on pruritus during maintenance hemodialysis (Chinese).
        Res Integrated Tradit Chin West Med. 2018; 10: 2
        • Hairong R
        • Weimin L
        • Jianping S
        Observation on the effect of acupuncture on 80 cases of uremia pruritus (Chinese).
        Chin Acupunct. 2002; 22: 235-236
        • Yan C
        • Yao W
        • Bao Y
        • et al.
        Effect of auricular acupressure on uremic pruritus in patients receiving hemodialysis treatment: a randomized controlled trial.
        Evid-Based Complement Altern Med. 2015; 2015593196
        • Juan F
        Application of integrated traditional Chinese and western medicine nursing in post-hemodialysis complications (Chinese).
        Bright Chin Med. 2021; 36: 3
        • Yueming W
        • Tieming M
        Effect of acupuncture pretreatment on serum IgE and expression of phosphorylated tyrosine protein kinase in skin tissue of urticaria rats.
        Acupunct Res. 2020; 45: 111-116
        • Che J
        The effect of acupuncture on serum IgE level in patients with chronic urticaria.
        J Tradit Chin Med. 2006; 26: 189-190
        • Kim K
        • Lee M
        • Choi S
        Acupuncture for treating uremic pruritus in patients with end-stage renal disease: a systematic review.
        J Pain Symptom Manage. 2010; 40: 117-125
        • Aval SB
        • Ravanshad Y
        • Azarfar A
        • Mehrad-Majd H
        • Ravanshad S
        A systematic review and meta-analysis of using acupuncture and acupressure for uremic pruritus.
        Iranian J Kidney Dis. 2018; 12: 78-83
        • Shamseer L
        • Moher D
        • Clarke M
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation.
        BMJ. 2015; 349: g7647
        • Keithi-Reddy SR
        • Patel TV
        • Armstrong AW
        • Singh AK
        Uremic pruritus.
        Kidney Int. 2007; 72: 373-377
        • Yichao F
        • Aihua S
        • Yu C
        To explore the efficacy of acupuncture combined with hemodiafiltration in the treatment of uremia skin itching (Chinese).
        Syst Med. 2020; 5: 19-21
        • National Administration of Traditional Chinese Medicine
        Criteria of diagnosis and therapeutic effect of diseases and syndromes in traditional Chinese medicine.
        Nanjing University Press, Nanjing1994: 147
        • Zheng X.
        Guidelines for clinical research of traditional Chinese medicine: part three.
        China Medical Science and Technology Press, Beijing2002: 86-88
        • Rui L
        Application of hemodialysis plus acupuncture in uremia pruritus (Chinese).
        Continuing Medical Education in China. 2015; 7: 2
        • Qiong Z
        Influence of acupuncture combined with drugs on calcium and phosphorus metabolism and complications in CKD patients undergoing MHD treatment (Master's thesis in Chinese).
        Jinan Universty, 2017
        • Tiancai H
        Efficacy of acupuncture combined with gabapentin in the treatment of uremic pruritus (Chinese).
        Inner Mongolia Tradit Chin Med. 2017; 36: 1
        • Liangzhe Z
        • Wenjuan X
        • Qiujing L
        • et al.
        Clinical efficacy of reinforcing-reducing acupuncture in the treatment of pruritus on maintenance hemodialysis and its effect on serum iPTH and β2 microglobulin (Chinese).
        J Chronic Dis. 2018; 19: 1763-1768
        • Cheng A
        • Wong L
        Uremic pruritus: from diagnosis to treatment.
        Diagnostics (Basel). 2022; 12: 1108
        • Scherer J
        • Combs S
        • Brennan F
        Sleep disorders, restless legs syndrome, and uremic pruritus: diagnosis and treatment of common symptoms in dialysis patients.
        Am J Kidney Dis. 2017; 69: 117-128
        • Xiong W
        • He F
        • You R
        • et al.
        Acupuncture application in chronic kidney disease and its potential mechanisms.
        Am J Chin Med. 2018; 46: 1169-1185
        • Wang S
        • Kain Z
        • White P
        Acupuncture analgesia: I. The scientific basis.
        Anesth Analg. 2008; 106: 602-610
        • Fonacier LS
        • Dreskin SC
        • Leung DY
        Allergic skin diseases.
        J Allergy Clin Immunol. 2010; 125: S138-S149
        • Dugas-Breit S
        • Schpf P
        • Dugas M
        • et al.
        Baseline serum levels of mast cell tryptase are raised in hemodialysis patients and associated with severity of pruritus.
        J Dtsch Dermatol Ges. 2005; 3: 343-347
        • Hwang J
        • Lio P
        Acupuncture in dermatology: an update to a systematic review.
        J Altern Complement Med. 2021; 27: 12-23
        • Simonsen E
        • Komenda P
        • Lerner B
        • et al.
        Treatment of uremic pruritus: a systematic review.
        Am J Kidney Dis. 2017; 70: 638-655