Effect of Topically Applied Olive Oil on Pruritus in Hemodialysis Patients: Pretest-posttest Model With Control Group

Chronic renal failure (CRF); is a condition that progresses with a progressive and irreversible decrease in glomerular filtration rate and nephron damage, disrupting the body's endocrine, metabolic and fluid-electrolyte balance. One of the methods of hemodialysis, peritoneal dialysis and kidney transplantation is required in the treatment of chronic renal failure. The most commonly used of these treatment methods is hemodialysis. Hemodialysis is a treatment method that regulates the fluid and solute balance of the blood taken from the patient through a machine containing a membrane. While the impaired renal functions of the patients are partially corrected with hemodialysis, significant complications also occur in many organs and systems. The most common problem related to the skin of these complications is pruritus. Pruritus is an unpleasant sensory and emotional experience that creates a scratching and rubbing sensation on the skin. Pruritus occurs continuously or intermittently in the form of attacks, widespread throughout the body or localized to a certain area, and occurs most frequently in the head, back, limbs and chest. In the pathogenesis of pruritus; skin dryness, proliferation of mast cells in the skin, release of proinflammatory cytokines such as C-Reactive protein (CRP) and interleukin-6 (IL-6), iron deficiency, dialysis-related allergic reactions, hypersensitivity, hypercalcemia, hyperphosphatemia, increased histamine, drugs, neuropathy, opioid system involvement, secondary hyperparathyroidism, increased serum vitamin A levels, serum bile acids, and uremic toxins play a role. Patients experiencing pruritus experience problems such as fatigue, sleep problems, anxiety, depression, social isolation, and aesthetic concerns, which reduce quality of life and personal care and make adaptation to the disease difficult. Secondary skin changes such as lesions, bleeding, delayed wound healing, mechanical skin damage, and infection may be observed in patients due to pruritus. Since the pathophysiology of pruritus is multifactorial and not fully understood, partially effective treatments are available. Studies have shown that many non-pharmacological interventions are effective in relieving pruritus in hemodialysis patients. Among these interventions, moisturizers have been found to be highly effective.

Olive oil is a product that can be easily absorbed from the skin, prevents fluid loss by accelerating the proliferation of the epidermis, increases the softness of the skin and thus moisturizes the skin and gives it elasticity, and has been widely used in skin care in recent years. A compound called oleocanthal, which forms the basis of the effects of nonsteroidal anti-inflammatory drugs and analgesics, has been identified in olive oil. Olive oil contains; antioxidant effect with vitamin E, increasing intravascular endothelial growth factor (VEGF) levels with phenolic compounds, photoprotection, anti-inflammatory, antimicrobial and antiaging effect, moisturizing effect with squalene, cell repair effect with oleic acid and linoleic acid, which has properties similar to breast milk. Since olive oil is completely compatible with human tissue cells thanks to its lipid composition, it is unlikely to cause an allergic reaction when applied to the skin, does not show any cytotoxic effect, and is an easy-to-obtain and use product.

Symptom management has an important place in nursing services. According to studies, pruritus is one of the most common symptoms and complaints in hemodialysis patients, more than half of the patients experience pruritus. Nurses should develop evidence-based solutions to reduce pruritus symptoms in hemodialysis patients and prevent secondary problems that may occur due to pruritus. This study was planned considering that olive oil's moisturizing and anti-inflammatory properties, which will help relieve skin dryness and inflammation, which play a role in the pathogenesis of pruritus, will be effective in solving the pruritus problem.

METHOD

Purpose of the Study: