Cutaneous Manifestations of End Stage Renal Disease (ESRD) on Hemodialysis in Libyan Patients

Abstract

Background: Chronic renal failure (CRF) is associated with various cutaneous manifestations, ranging from xerosis and hyperpigmentation to severe, life-threatening pruritus. Hemodialysis interventions have introduced different and newer dermatological presentations in CRF patients. Aims of the Study: This study aimed to assess the frequency of skin manifestations in Libyan patients with chronic renal failure undergoing hemodialysis. Materials and Methods: A total of 100 CRF patients on hemodialysis attending the hemodialysis unit at Ibn-Sina Teaching Hospital, Sirte, Libya, participated in this cross-sectional study. A comprehensive medical history was obtained, along with blood pressure measurement and a full clinical dermatological examination. Blood investigations included fasting blood sugar, HbA1c, hemoglobin, serum creatinine, and blood urea. Skin biopsies and additional investigations were performed when necessary. Results: Among the 100 patients included, 54% were male and 46% were female, with an age range of 20 to 87 years (mean: 54.3 years; SD=14.5). Hypertension was present in 74% of patients, diabetes mellitus in 23%, and 6% had no comorbidities. Ninety-one percent of patients exhibited at least one cutaneous manifestation. The average CRF duration was 10.3 years. The most common dermatological findings were pruritus (67%), nail changes (45%), xerosis (36%), pallor (34%), pale nails (32%), hyperpigmentation (20%), and infections (14%). Rare manifestations included uremic nephropathy (5%), calcification (4%), bullous disease (2%), Kyrle disease (1%), and uremic frost (1%). Pruritus was reported in 71% of hypertensive patients and 65% of diabetics, whereas pallor was noted in 39% of hypertensive patients and 22% of diabetics. Calcification, hyperpigmentation, and xerosis were more prevalent in females. Pruritus, xerosis, pallor, and pale nails showed a significant age-related increase (p<0.05), and fungal infections were predominantly observed in patients ≥60 years. Conclusion: The most frequent cutaneous manifestations observed in this study were pruritus, nail changes, xerosis, pallor, hyperpigmentation, and infections. Early identification of these dermatological signs can help alleviate patient discomfort and reduce morbidity.