Application of Acupressure in Reducing Pruritus Scale in Hemodialysis Patients

Abstract

Pruritus is a common problem in patients with chronic kidney disease who undergo dialysis. It is characterized by an uncomfortable sensation that leads to scratching. Acupressure is a complementary method used to manage various symptoms and health problems, including pruritus. This study aims to identify the effect of acupressure at the LI-11 point in reducing pruritus in a hemodialysis patient. This study used pre-experimental research with pre- and post-test without control. This study occurs in a hemodialysis unit in Central Jakarta, Indonesia. The sample was comprised of 19 respondents in the hemodialysis unit who met the inclusion criteria and completed the study. Respondents received acupressure in the LI-11 point two times per week for four weeks for a total of eight sessions. Data were collected using individual characteristics questionnaire, pruritus characteristics, and Visual Analog Scale (VAS) for pruritus. The data analysis used was a dependent t-test. The majority of respondents were male with duration of hemodialysis 5 hours, mean of age 53 years, mean of length of HD is 53 months, mean of Hb level is 9.67 gr/dl, mean of urea level is 117.05 mg/dl, mean of creatinine is 10.26 mg/dl. The results indicate that acupressure has a significant effect in reducing of pruritus scale (p-value 0,000). This study recommends nurses to be able to use acupressure therapy to reduce the scale of pruritus experienced by hemodialysis patients.


 


Keywords: acupressure, pruritus, hemodialysis

References
[1] Himmelfarb, J. (2010). Hemodialysis. The New England Journal of Medicine, vol. 363, issue 19, pp. 1833–1845.


[2] PERNEFRI. (2018). 11th Report of Indonesian Renal Registry 2018. Retrieved from https://www. indonesianrenalregistry.org/data/IRR2018.pdf.


[3] Kavurmaci, M. (2015). Prevalence of Uremic Itching in Patients Undergoing Hemodialysis. Hemodialysis International, vol. 19, issue 4, pp. 531–535.


[4] Mathur, V. S., et al. (2010). A Longitudinal Study of Uremic Pruritus in Hemodialysis Patients. Clinical Journal of the American Society Nephrology., vol. 5, issue 8, pp. 1410–1419, doi: 10.2215/CJN.00100110.


[5] Narita, I., et al. (2008). Uremic Pruritus in Chronic Hemodialysis Patients. Journal of Nephrology, vol. 21, issue 2, pp. 161–165.


[6] Ozen, N., et al. (2018). Uremic Pruritus and Associated Factors in Hemodialysis Patients: A Multi-Center Study. Kidney Research and Clinical Practice, vol. 37, issue 2, pp. 138–147.


[7] Gobo-Oliveira, M., et al. (2017). Factors Associated with Uremic Pruritus. International Archives of Medicine, vol. 10, pp. 1–8.


[8] Araujo, S. M. H. A., et al. (2012). Risk Factors for Depressive Symptoms in a Large Population on Chronic Hemodialysis. International Urology and Nephrology, vol. 44, issue 4, pp. 1229–1235.


[9] Rehman, I. U., et al. (2018). Prevalence of Chronic Kidney Disease-Associated Pruritus, and Association with Sleep Quality among Hemodialysis Patients in Pakistan. PLoS ONE, vol. 13, issue 11, pp. 1–18.


[10] Narita, I., et al. (2006). Etiology and Prognostic Significance of Severe Uremic Pruritus in Chronic Hemodialysis Patients. Kidney International. Elsevier Masson SAS, vol. 69, issue 9, pp. 1626–1632.


[11] Aramwit, P. and Supasyndh, O. (2015). Uremic Pruritus; Its Prevalence, Pathophysiology and Management. In H. Suzuki (Ed.), Updates in Hemodialysis (pp 19-41). Croatia: InTech. doi: 10.5772/59352.


[12] Pisoni, R. L., et al. (2006). Pruritus in Haemodialysis Patients: International Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrology Dialysis Transplantation, vol. 21, issue 12, pp. 3495–3505, doi: 10.1093/ndt/gfl461.


[13] Berger, T. G. and Steinhoff, M. (2011). Pruritus and Renal Failure. Seminars in Cutaneous Medicine and Surgery, vol. 30, issue 2, pp. 99–100, doi: 10.1016/j.sder.2011.04.005.


[14] Marquez, D., et al. (2012). Uremic Pruritus in Hemodialysis Patients: Treatment with Desloratidine Versus Gabapentin. Jornal Brasileiro de Nefrologia: ’orgão oficial de Sociedades Brasileira e LatinoAmericana de Nefrologia, vol. 34, issue 2, pp. 148–152, doi: 10.1590/S0101 28002012000200007.


[15] Bonchak, J. G. and Lio, P. A. (2020). Nonpharmacologic Interventions for Chronic Pruritus. Itch, vol. 5, issue 1, p. e31, doi: 10.1097/itx.0000000000000031.


[16] Akça, K. N., Taşçi, S. and Karataş, N. (2013). Effect of Acupressure on Patients in Turkey Receiving Hemodialysis Treatment for Uremic Pruritus. Alternative Therapies in Health and Medicine, vol. 19, issue 5, pp. 12–18.


[17] Yan, C. N., et al. (2015). Effect of Auricular Acupressure on Uremic Pruritus in Patients Receiving Hemodialysis Treatment: A Randomized Controlled Trial. Evidence-based Complement. Alternative Medicine, vol. 2015, pp. 1-8, doi: 10.1155/2015/593196.


[18] Aval, S. B. (2018). A Systematic Review and Meta-analysis of Using Acupuncture and Acupressure for Uremic Pruritus. Iranian Journal of Kidney Disease, vol. 12, issue 2, pp. 78–83.


[19] Najafi, S. S., et al. (2019). The Effect of Manual Acupressure (Point BL32) on Pain Associated with Intramuscular Injections of Magnesium Sulfate. JAMS Journal of Acupuncture and Meridian Studies, vol. 12, issue 2, pp. 67–72, doi: 10.1016/j.jams.2018.07.002.


[20] Song, H. J., et al. (2015). Effect of Self-Acupressure for Symptom Management: A Systematic Review. Complementary Therapies in Medicine, vol. 23, issue 1, pp. 68–78, doi: 10.1016/j.ctim.2014.11.002.


[21] K