Discussion
bleeding, itching, itch, HD, sexual complaint, pruritus, Uremic pruritus, depression, Depression
HYPERPARATHYROIDISM, BLEEDING, ADVERSE EVENTS, HYPERPHOSPHATEMIA, ADVERSE EVENT, PATHOGENESIS
Uremic pruritus is a frequent and annoying symptom in hemodialysis patients, and therefore drugs with enhanced efficacy and good tolerability are needed. In the present study, sertraline significantly improved pruritus intensity, as compared with placebo.The problem with UP is that its pathogenesis is multifactorial and not clear [Depression affects pruritus patients more frequently, and depression can intensify itching [The efficacy of sertraline in our work (assessed by 5-D itch scale) was comparable to the outcomes of other UP medications such as difelikefalin [In the present work, we found a statistically significant relation between pruritus and serum urea. The dialysis adequacy in both groups (represented as Kt/V) was slightly less than the target values in HD patients and this could explain our finding. Similar findings were reported by other researchers [We found no association between pruritus and calcium, phosphorus, PTH, serum albumin, and Kt/V. This might be due to our exclusion of patients with hyperphosphatemia, hyperparathyroidism, or high Ca X Ph product from the study. This is consistent with the findings of other studies [Regarding sertraline safety, we found no significant difference in the reported adverse events in both groups. Also, no major adverse event, bleeding, new sexual complaint, nor QT interval prolongation were reported in the sertraline group. These findings support the data [The strengths of our study include being one of the largest trials to investigate sertraline effects on UP till now. Also, we used two itch scores to support our findings and the results were consistent in both. A possible drawback of our study might be the follow up period (8 weeks), longer durations would have strengthen our findings. Also, the Kt/V in both groups was slightly less than the required value (1.2) in HD patients.