Abstract: 【Abstract】Objective To observe the effect of sodium thiosulfate combined with hemoperfusion on refractory pruritus and oxidative stress in maintenance hemodialysis (MHD) patients. Methods A total of 70 MHD patients with refractory pruritus treated in the Hemodialysis Center, Shanghai Jing’an District Zhabei Central Hospital during January 2019 to December 2020 were enrolled in this study. They were randomly divided into three groups: group A (sodium thiosulfate group), group B (hemoperfusion group) and group C (sodium thiosulfate combined with hemoperfusion group). Patients in group A received hemodialysis three times a week, and 3.2g sodium thiosulfate was intravenously injected before every dialysis; those in group B received hemodialysis twice a week and hemodialysis combined with hemoperfusion once a week; those in group C used the dialysis protocols in group B as well as intravenous 3.2g sodium thiosulfate before every dialysis for 3 months. Serum creatinine (SCR), urea nitrogen (BUN), calcium (Ca), phosphorus (P), β2-micro-globulin (β2-MG), parathyroid hormone (PTH), C-reactive protein (CRP), glutathione peroxidase (GSHPx), superoxide dismutase (SOD) and malondialdehyde (MDA) were measured before and after 3 months treatment. Pittsburgh sleep quality index (PSQI) and visual analogue scale (VAS) were used before and after 3 months treatment to evaluate the efficacy and safety of the treatment. Results Serum P, β2-MG and PTH in group B and group C were lower after the treatment than those before the treatment, and were lower than those in group A after the treatment (Serum P, in group B and group C: t=2.829 and 4.226, P=0.010 and <0.001; between group B and group C: F=3.191 and P=0.041. Serum β2-MG, in group B and group C: t=2.363 and 2.575, P=0.027 and 0.017; between group B and group C: F=4.658 and P=0.013. Serum PTH, in group B and group C: t=2.715 and 5.856, P=0.008 and <0.001; between group B and group C: F=13.738 and P<0.001). Serum GSHPx and SOD in group A and group C were higher after the treatment than those before the treatment, and were higher than those in group B during the same period (Serum GSHPx, in group A and group C: t=-2.247 and - 5.387, P=0.035 and <0.001; between group A and group C: F=15.577 and P<0.001. Serum SOD, in group A and group C: t=-2.300 and -5.122, P=0.031 and <0.001; between group A and group C: F=8.308 and P=0.001). Serum MDA decreased significantly (in group A and group C: t=5.630 and 7.904, P<0.001; between group A and group C: F=26.116 and P<0.001). PSQI score and VAS score lowered after 3 months treatment compared to those before treatment in the three groups (PSQI score in groups A, B and C: t=4.739, 4.761 and 8.803 respectively, P<0.001; VAS score in groups A, B and C: t=15.087, 11.682 and 17.310 respectively, P<0. 001). PSQI and VAS scores lowered more in group C than in group A and group B during the same period (For PSQI score and VAS score: F=15.049 and 8.670, P<0.001). After 3 months treatment, the effective rates were 54.2%, 47.8% and 78.3% in group A, group B and group C, respectively, higher in group C than in groups A and B (χ2=4.956, P=0.026). Conclusions Sodium thiosulfate combined with hemoperfusion was safe and effective for MHD patients with refractory pruritus. Sodium thiosulfate has antioxidant effect, which may alleviate uremic pruritus.

Key words: Sodium thiosulfate, Hemoperfusion, Pruritus, Oxidative stress