Quantitative Comparison of Skin Colors in Patients With ESRD Undergoing Different Dialysis Modalities

Background: Little is known about the alterations in skin pigmentation in patients with end-stage renal disease (ESRD) in the modern dialysis era. Aims of this study are to quantitatively investigate the skin color of patients with ESRD undergoing different dialysis modalities and determine factors associated with skin color changes. Methods: One hundred twenty-four patients with ESRD undergoing either hemodialysis (HD; n = 51) or peritoneal dialysis (PD; n = 73) were enrolled, and 59 subjects with normal renal function served as controls. Skin colors of the abdomen (non-sun-exposed site) and forearm (sun-exposed site) were measured by using a reflected-light colorimeter and recorded by using the Commission Internationale de l'Eclairage recommended L*a*b* system, in which a higher L* value represents brighter skin. Results: For sun-exposed skin, brightness was not different between patients with ESRD and controls. However, patients with ESRD had a lower L* value in the non-sun-exposed skin area (P < 0.001). HD and PD patients had similar L* values in both sun-exposed and non-sun-exposed skin areas. PD patients with adequate weekly creatinine clearance or residual urine greater than 100 mL/d had brighter skin in the non-sun-exposed area (P = 0.001 and P = 0.035, respectively). Conclusion: Patients with ESRD in Taiwan have significantly darker skin in the non-sun-exposed area, but not the sun-exposed area, than subjects with normal renal function. However, there is no difference in skin darkness between HD and PD patients. Efforts to increase weekly creatinine clearance and preserve residual urine may alleviate hyperpigmentation in PD patients.