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

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, likenephrogenic systemic fibrosis, which is a rare entity in current times. The present study was done to evaluate the spectrumof mucocutaneous manifestations in patients with CKD and to look for an association between them and various biochemicalparameters and inflammatory markers. Material and methods: This study was a 1 year prospective, observational studyconducted on adult patients with CKD who presented to the Nephrology clinic in Pt. BD Sharma PGIMS, Rohtak. Patientsbetween the ages of 17 and 75 years with CKD stages II or more with dermatological conditions were included in thisstudy. Each participant was subjected to detailed clinical, biochemical, radiological and dermatological examination bysame consultants in order to avoid interpersonal variations. Various skin, mucosal, nail and hair manifestations along withcutaneous infections were analyzed across the spectrum of CKD. Results: Among cutaneous infections, fungal infectionspredominated, amongst which, onychomycosis was the most common. Xerosis was the most common dermatological diseaseand the prevalence of xerosis, skin pallor and pruritus was found to increase significantly from Stage II to Stage V and VDof CKD in a statistically significant manner. An association was found between xerosis and decreasing levels of hemoglobinand 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 withxerostomia and nail pallor as compared with those who did not have these conditions. Lastly, patients with nail pallorhad significantly lower albumin. Conclusion: It was observed in our study that in CKD patients on hemodialysis and onconservative management, xerosis, pruritus, pigmentation, nail changes, oral mucosa changes and cutaneous infections werethe predominant cutaneous manifestations. In patients with CKD, mucocutaneous manifestations progressively worsenedas renal function deteriorated.