What are the primary dermatologic manifestations associated with uremia in end-stage renal disease (ESRD)?

Updated: Mar 05, 2020
  • Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD  more...
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The lives of many patients with end-stage renal disease (ESRD) are maintained by either hemodialysis or peritoneal dialysis. Unfortunately, dialysis cannot compensate completely for the changes associated with kidney dysfunction. Renal replacement modalities are not as efficient in removing many of the substances readily cleared by a healthy kidney. Nor can dialytic therapy replace the endocrine function lost with renal failure. Most patients with ESRD develop significant metabolic abnormalities, which are related directly to the loss of kidney function.

Acquired abnormalities are numerous and include the development of a metabolic acidosis and anemia, as well as an alteration in calcium-phosphate homeostasis, hyperparathyroidism, hyperlipidemia, and glucose intolerance. These metabolic changes predispose patients with ESRD to bone disease, vascular calcification, and an increase in cardiovascular morbidity and mortality.

In the late 1980s, recombinant erythropoietin became available and has helped alleviate the anemia associated with uremia. Before widespread use of recombinant erythropoietin, many patients required frequent transfusions to maintain an adequate hematocrit. Individuals who required multiple transfusions were at high risk for developing iron overload, as well as hepatitis C (HCV) infection. The amalgamation of these numerous and hazardous metabolic abnormalities is responsible for most of the clinical characteristics of the uremic condition.

Many of the dermatologic manifestations associated with uremia, such as pruritus and xerosis, are prevalent in the ESRD population but are not specific for uremia.

Other manifestations, especially those related to the dialysis procedure, are unique to this population but are not discussed in this article. (See Calcinosis Cutis, Calciphylaxis, Kyrle Disease, Bullous Disease of Dialysis, Nephrogenic Fibrosing Dermopathy.)

This section discusses the other primary dermatologic manifestations associated with uremia including the following:

  • Xerosis

  • Pruritus

  • Pigmentary alteration

  • Half-and-half nails

  • Alopecia

  • Uremic frost

  • Porphyria cutanea tarda

  • Arterial steal syndrome

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