Topisch appliziertes L-Argininhydrochlorid verbessert Hauttrockenheit und Pruritus bei Patienten unter chronischer Hämodialyse - eine Vehikel-kontrollierte prospektive randomisierte Studie im Halbseitenvergleich

BACKGROUND: The uraemic pruritus is a very painful symptom affecting haemodialysis patients and is observed in 50 to 90 % of patients. The etiology of uraemic pruritus have not yet been clarified. Only after kidney transplantation with a functioning transplant the uraemic pruritus is stopped. This is why no causal therapy exists so far. PATIENTS AND METHODS: We examined in 24 chronic dialysis patients over six weeks the topical effect of a 2.5 % L-arginine hydrochloride ointment (week 1 to 4) in comparison to an active agent free ointment for skin dryness, pruritus, erythema and desquamation. The control group consisted of 12 subjects of healthy skin and kidneys. RESULTS: Skin hydration and the pruritus of haemodialysis patients could be significantly improved by the active agent and the vehicle preparations with the active agent being clearly more effective. An improvement of erythema and desquamation could only be achieved by the active agent preparation. The values measured by corneometry showed a stronger increase of skin hydration through the active agent preparation. The values measured by tewametry showed no difference between active agent and vehicle preparation. CONCLUSIONS: The positive effect of 2.5 % L-arginine hydrochloride ointment on uraemic pruritus can be theoretically explained insofar that L-arginine as a substrate of NOS isoforms prompts the immunomodulatory, anti-microbial and vasodilative properties of NO to become effective.