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Dialysis

A review of the use of dialysis in the treatment of psoriasis.

Dialysis is a process of artificially cleaning a person’s blood. It is typically only used on patients with kidney failure, but in the late 1960s, and early 1970s, reports indicated that dialysis might be effective in the treatment of psoriasis.

There are two main types of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, blood is withdrawn from the body, passed through a machine (sometimes called an artificial kidney) which filters it and combines it with a solution called dialysate before pumping it back into the body. In peritoneal dialysis, the lining of the abdominal cavity (the peritoneum) is used as the filter instead of an artifical filter — the abdominal cavity is filled with dialysate, absorbs waste from the blood, and is later drained out again.

Both kinds of dialysis have been done since the 1940s, but it wasn’t until the 1960s that they became standard treatments for kidney failure. It appears, from what I can find, that some people with psoriasis who experienced kidney failure of one form or another found that their psoriasis went away while on dialysis. This seems to have prompted serious clinical trials in the 1970s, testing to see if dialysis by itself could effect psoriasis.

And the answer appears to be “yes, sometimes.” Peritoneal dialysis is generally regarded to reduce psoriasis symtoms better than hemodialysis does, but not everyone responds to either one. And there is at least one report in the literature of a person getting psoriasis after starting dialysis, though there may have been other factors at work.[1]

From the study abstracts I’ve seen, dialysis (either peritoneal or hemo-) tends to do pretty well. One study claimed that both Peritoneal dialysis and hemodialysis were better than Goeckerman Therapy as far as the duration of remission went (but not in terms of how much clearing was induced).[2] Other studies on dialysis and other types of blood filtration have shown (results of multiple studies combined):

Type of Dialysis	Patients Cleared or Markedly Improved	Patients with Little or No Improvement
Peritoneal Dialysis[3-10]	49 (73%)	18 (27%)
Hemodialysis[10-14]	21 (62%)	13 (38%)
Unknown[15]	36 (29%)	88 (71%)
Sham (Fake) Dialysis[4]	0 (0%)	5 (100%)
Plasma Exchange/Leukapheresis[16]	0 (0%)	9 (100%)
Hemofiltration/Ultrafiltration[17]	6 (38%)	10 (62%)
Oral Dialysis[18]	0 (0%)	10 (100%)

And the reason why you, perhaps an average Joe or Jane Psoriatic, may not have heard that dialysis is useful for psoriasis at all is that other, newer therapies are less invasive and less risky (both types of dialysis involve tubes which stick out of the body — a ready site for infection), and also less expensive.

According to a variety of sources on the web, hemodialysis costs anywhere between $27,000 (US$) and $63,000 per year, for a whole year of treatment.[19-22] These same estimates show that while peritoneal dialysis is cheaper, it is only (on average) 23% cheaper, still costing well over $42,000. But, that’s for a full year of treatment, which isn’t necessary for psoriasis. Still, just a month of treatment would probably run around $3,500 — and that’s if you avoid peritonitis. It’s more than likely that insurance will never cover dialysis for psoriasis, even in part.

In 1985, dialysis for psoriasis was still considered experimental.[23] The last “serious” study of dialysis for psoriasis was published in 1987.[2] One of the latest reviews of peritoneal dialysis for psoriasis, published in 2000, says, in no uncertain terms, that peritoneal dialysis is obsolete for psoriasis.[24]

It should also be noted that patients who use methotrexate and dialysis at the same time need to be closely monitored.[25] Dialysis can play havoc with the amount of the drug in the body.

Toxins?

Papers from the Meridian Institute and other proponents of Edgar Cayce’s psychic readings about psoriasis take the results of certain dialysis trials for psoriasis as proof that Cayce was correct in his claims that psoriasis is caused by “toxins” leaking from the intestines, overwhelming the waste-elimination systems of the body, and instead being expelled by the skin.[26-28] However, since psoriatics with failed kidneys clear up on dialysis better than people with good kidneys, the “toxin removal” hypothesis is questionable.

Another reason to question it is that peritoneal dialysis, which by some accounts removes fewer waste products than hemodialysis, works better for psoriasis. And plasma replacement, in which the plasma portion of a person’s blood is physically replaced with new plasma (instead of their own plasma, filtered), doesn’t work at all. The “toxins” would have to reside within or on the red or white blood cells, which no one has suggested.

One study suggested that removal of immune complexes from the blood is the reason dialysis works.[29] Immune complexes are not toxins, generally. And at least one study tentatively identified some genetic markers which, they say, help identify people for whom dialysis will work, indicating again that more is going on than simple “toxin removal.”[14]

Some doctors have suggested that something within the dialysate itself, going into the body, reduces psoriasis. This is, of course, questionable as well. The short answer is that nobody really knows why dialysis works, and it’s doubtful that anyone will test it further in order to find out why it works as well as it does.

The researchers at the Meridian Institute, along with many others, who suggest that psoriasis is caused by mysterious, unspecified, unmeasured “toxins” which behave in ways that other genuine toxins don’t, are looking for an easy answer to a very complex problem.

November 22, 2002, Update: Hemoperfusion is another method of cleansing the blood, which typically removes larger molecules than does hemodialysis, but is otherwise largely the same process, from the patient’s point of view. In hemoperfusion, blood flows through a “sorbent,” which is a material like activated charcoal or resin, and molecules within the blood adsorb onto the sorbent and stay there. The cleaned blood is returned to the patient’s body. In the U.S.A., it appears that hemoperfusion is used mostly for cases of drug overdose or other poisonings, but that’s mostly a first impression.

Russian researchers have been looking at hemoperfusion for the treatment of psoriasis since 1980, but many of their papers do not have abstracts in Medline. The ones which do paint a picture in which not many controlled trials have been done, but researchers are trying different sorbents (even pig spleen) to see which works best for different diseases.[30-34] One study found at least an improvement in symptoms in 86% of patients during an uncontrolled trial, but only 55.5% had a significant improvement during a controlled trial (only 1 out of the 9 control patients improved).

There’s also been research into the serum levels of certain molecules before, during, and after hemoperfusion, and also studies of the molecules adsorbed onto the carbon.[35-37] These seem to lend credence to the theory that some immune-system components are being removed, and they are — at least in part — responsible for psoriasis symptoms.

And finally, one abstract showed that cortisol, one of the body’s own steroids, is removed during hemoperfusion (with a cellulose-acetate-coated charcoal sorbent), which could indicate that long-term hemoperfusion could carry a risk of endocrine imbalance.[38] For psoriasis, this is also important as it (theoretically) could lead to a rebound effect after treatment is complete (although how often this might occur, or how severe it would be, I can’t say). On a side note, serum levels of testosterone also dropped during hemoperfusion in this trial.

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Footnotes

The information provided here is not medical advice. This is not a self-help web site. Seek professional advice before beginning, ending, or changing treatments for any disease or condition. See the legal info page for more information.

This page created on 20021030, and last modified on 20100430.
Copyright © 2002 by Dave W.

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