Spectrum of Skin Manifestations in CKD: A Tertiary Care Center Experience from North India

Abstract

Introduction: Dermal manifestations in chronic kidney disease (CKD) patients may range from mild ones, like xerosis,
skin pallor, pruritus, coated tongue, superficial infections and hair and nail changes, to severe life-threatening ones, like
nephrogenic systemic fibrosis, which is a rare entity in current times. The present study was done to evaluate the spectrum
of mucocutaneous manifestations in patients with CKD and to look for an association between them and various biochemical
parameters and inflammatory markers. Material and methods: This study was a 1 year prospective, observational study
conducted on adult patients with CKD who presented to the Nephrology clinic in Pt. BD Sharma PGIMS, Rohtak. Patients
between the ages of 17 and 75 years with CKD stages II or more with dermatological conditions were included in this
study. Each participant was subjected to detailed clinical, biochemical, radiological and dermatological examination by
same consultants in order to avoid interpersonal variations. Various skin, mucosal, nail and hair manifestations along with
cutaneous infections were analyzed across the spectrum of CKD. Results: Among cutaneous infections, fungal infections
predominated, amongst which, onychomycosis was the most common. Xerosis was the most common dermatological disease
and the prevalence of xerosis, skin pallor and pruritus was found to increase significantly from Stage II to Stage V and VD
of CKD in a statistically significant manner. An association was found between xerosis and decreasing levels of hemoglobin
and while ferritin was not different between patients with and without xerosis, high-sensitivity C-reactive protein (hs‐CRP)
was significantly higher in patients with xerosis. Similarly, hs-CRP levels were significantly elevated in patients with
xerostomia and nail pallor as compared with those who did not have these conditions. Lastly, patients with nail pallor
had significantly lower albumin. Conclusion: It was observed in our study that in CKD patients on hemodialysis and on
conservative management, xerosis, pruritus, pigmentation, nail changes, oral mucosa changes and cutaneous infections were
the predominant cutaneous manifestations. In patients with CKD, mucocutaneous manifestations progressively worsened
as renal function deteriorated.