Table 1.
Characteristics of included studies.
| Study (year) | Study design | Inclusion criteria | No. of patients | Age (year-old) | Treatment (route, dosage, and frequency) | Control (route, dosage, and frequency) |
Concomitant
treatment |
Duration | Inspection data | Pruritus severity assessment tool | PS (before → after), experimental control | Effective rate | Follow up duration | Acupoint |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Acupuncture | ||||||||||||||
| Ardinata et al. (22) | RCT | HD | T: 30 C:30 |
T: – C: 25~77 |
A (3 times/W) HD | Placebo + HD |
Conventional Tx |
12 W | IL-31 | 5DIS | T: 1 (1–5) → 1 (1–5) 4 (2–5) → 2 (1–4) 4 (2–5) → 3 (2–4) 3 (1–5) → 2 (1–4) C: 2 (1–5) → 1.5 (1–5) 4 (2–5) → 3 (1–5) |
NA | NA | LI11 |
| Fan et al. (23) | RCT | HD | T: 22 C:20 |
T: 62.4 (4.10) C: 63.2 (4.50) |
A (3 times/W) HD | Conventional western medicine |
Conventional Tx |
12 W | Ca, P, BUN, Cr | Grade, distribution, sleep |
T: 38.20 (4.80) → 17.30 (5.50) C: 38.30 (4.30) → 37.50 (3.20) |
NA | NA | LI11 |
| Jiang et al. (24)† | RCT | HD | T1 (hemoperfusion): 14 T2 (hemoperfusion + A): 14 C: 14 |
T1: 72.43 (7.56) T2: 73.50 (7.77) C: 72.93 (9.09) |
Hemoperfusion A (3 times/W) HD |
Placebo + HD |
Conventional Tx |
NA | Ca, P, iPTH, hs-CRP, IL-6 | VAS 5DIS |
T1: 2 (3.70) → 1 (3.29) T2: 1.5 (3.08) → 0 (0.61) → 0 (0.61) C: 2.00 (3.70) T1: 13.5 (8.64) → 8.5 (5.76) T2: 13.5 (7.00) → 6.5 (4.11) C: 9.5 (8.44) → 10 (8.23) |
NA | NA | LI4 LI11 SP6 SP10 ST36 |
| Zhang et al. (25) | RCT | HD | T: 30 C: 33 |
T: 53.63 (9.40) C: 52.23 (7.95) |
A (3 times/W) + HD | HD | Conventional Tx |
4 W | CRP, Hb, albumin, BUN, Cr, Ca, P, PTH, Eosinophil, IgE | VAS |
ΔT: 5 (3–8) ΔC: 2 (−1–4) |
T: 13/35 C: 2/35 |
NA | LI11 SP10 SP6 |
| mDUO |
ΔT: 6.23 (4.83) ΔC: 1.73 (2.82) |
|||||||||||||
| TCM syndrome score |
ΔT: 9 (7–11) ΔC: 0 (−0.5–2) |
|||||||||||||
| Liu et al. (26) | RCT | HD | T: 40 C: 40 |
T: 54.80 (3.20) C: 53.50 (4.60) |
A (3 times/W) + HD | HD | Conventional Tx |
4 W | Ca, P, PTH, histamine | Distribution, frequency, severity, sleep | Distribution T: 2.45 (0.87) → 1.41 (0.52) C: 2.49 (0.83) → 2.34 (0.78) Frequency T: 3.69 (1.21) → 1.52 (0.52) C: 3.72 (1.32) → 3.63 (1.53) Severity T: 3.59 (1.12) → 1.32 (0.45) C: 3.61 (1.14) → 3.21 (1.43) Sleep T: 7.33 (2.14) → 2.14 (0.89) C: 7.45 (2.18) → 7.23 (2.09) |
NA | NA | LI11 SP6 |
| Nahidi et al. (27) | RCT | HD | T: 15 C: 11 |
T: 54.67 (11.40) C: 41.36 (16.21 |
A (3 times/W) + HD | Placebo + HD | Conventional Tx |
6 W | NA | VAS | T: 9.87 (0.35) → 3.93 (2.85) C: 9.45 (0.93) → 8.18 (1.40) | NA | NA | SP6 SP10 LIV3 LI4 |
| Phan et al. (28) | RCT | HD | T: 18 C: 19 |
T: 45.72 (10.08) C: 48.37 (10.81) |
A (2 times/W) + HD | Placebo + HD | Conventional Tx |
6 W | NA | 5DIS | T: 12.00 (3.27) → 7.89 (0.83) C: 12.74 (3.07) → 10.63 (3.17) |
NA | 8 W | LI11 Quchi |
| Chu et al. (29) | RCT | HD | T: 20 C: 20 |
T: 44.80 (11.50) C: 45.50 (12.00) |
A (2 times/W) + HD | Loratidine (10 mg QD) +HD | Conventional Tx |
12 W | BUN, Cr, P, PTH, β2-MG | VAS | T: 8.65 (1.24) → 1.45 (0.58) C: 8.60 (1.18) → 5.24 (1.28) |
T: 19/20 C: 13/20 |
NA | SP10 ST36 SP6 LI4 LI11 DU20 |
| VAG | T: 7.52 (0.64) → 2.80 (0.65) C: 7.38 (0.45) → 5.75 (1.85) |
|||||||||||||
| Pu et al. (30) | RCT | HD | T: 27 C: 27 |
T: 63.52 (5.18) C: 63.42 (5.32) |
A (2 times/W) + HD | HD | Conventional Tx |
10 D | NA | Dirk. R. Kuypers scale (DRKS) | T: 25.5 (5.3) → 10.4 (3.4) C: 25.2 (5.1) → 18.9 (4.1) |
T: 24/27 C: 20/27 |
NA | LI4 LI11 ST36 LU5 |
| Chang et al. (31) | RCT | HD | T1 (A): 16 T2 (citrate): 17 C: 17 |
Total: 45.30 (18.90) | T1: A + HD T2: citrate dialysate |
HD | Conventional Tx |
Not mentioned | CRP, WBC | Guidelines for clinical research of Traditional Chinese Drug Research | T1: 12.12 (1.78) → 9.16 (1.67) T2: 12.17 (1.75) → 4.08 (1.84) C: 12.08 (1.82) → 10.80 (1.96) |
T1: 9/16 T2: 15/17 C: 2/15 |
NA | LI11 GB31 ST36 SP10 BI17 |
| Ono et al. (32) | P-RCT | HD | T: 24 C: 23 |
T: 70.00 (9.60) C: 67.30 (13.00) |
A (1 time/W) + HD + M-test | HD | T: 0.66 (0.15) → 0.76 (0.17) C: 0.64 (0.18) → 0.64 (0.18) | 8 W | Ca, P, Hb, Cr, BUN, albumin, leukocyte | NRS | 60 → 18 | NA | 12 W | LU5 LU9 LI2 LI11 HT7 HT9 SI3 SI8 PC7 PC9 TE3 TE10 SP2 SP5 ST41 ST45 KI1 KI7 BL65 BL67 LR2 LR8 GB38 GB43 |
| Utility | ||||||||||||||
| Ma et al. (33) | RCT | HD | T: 23 C: 23 |
T: 64.33 (13.77) C: 60.74 (16.36) |
A (3 times/W) + HD | HD | Conventional Tx |
16 W | NA | Clinical effect | NA | T: 18/23 C: 1/19 |
NA | SP10 LI4 |
| mDuo | T: 14.96 (5.89) → 4.35 (4.74) C: 19.45 (8.71) → 20.21 (8.48) |
|||||||||||||
| Chang et al. (34) | RCT | HD | A+HDF: 15 HDF: 15 C (HD): 16 |
A+HDF: 52.30 (12.60) HDF: 49.60 (13.40) C: 53.20 (15.90) |
A (2 times/W) + HD + HDF | HDF and HD | Conventional Tx |
12 W | P, PTH | NA | NA | A+HDF: 13/15 HDF: 10/15 C: 3/16 |
NA | LI4 LI11 ST36 SP10 LU5 BI17 |
| FIIQ | T: 13.03 (1.96) → 8.56 (1.76) C: 12.22 (2.10) → 10.08 (1.84) |
|||||||||||||
| Yu et al. (35) | RCT | HD | T: 50 C: 50 |
T: 55.60 (1.90) C: 53.60 (2.50) |
Auricular scraping (1 time/W) | Loratidine 10 mg/d | Conventional Tx |
4 W | NA | VAS FIIQ |
NA T: 8.42 (3.30) → 5.41 (2.25) C: 8.48 (4.21) → 6.79 (3.02) |
T: 43/50 C: 38/50 |
8 W | Lung Large intestine Shenmen (TF4) Endocrine (CO18) Adrenal gland Occiput |
| Zhai et al. (36) | RCT | HD | T: 50 C: 50 |
T: 62.98 (3.65) C: 63.23 (3.92) |
AA (4 times/d) + HD | Loratadine (10 mg QD) + HD | Conventional Tx |
12 W | NA | PSQI | T: 20.21 (2.15) → 13.67 (2.97) C: 20.34 (2.72) → 17.13 (2.12) |
Itching: T: 46/50 C: 38/50 |
NA | Kidney Spleen Stomach Sympathy Subcortical TF4 |
| Che et al. (5) | RCT | HD | T: 20 C: 20 |
T: 62.40 (9.10) C: 63.20 (7.50) |
A (2 times/W) + HD | Placebo needle + HD | Conventional Tx |
4 W | NA | severity, distribution, sleep disturbance questionnaire | T: 38.20 (4.80) → 17.30 (5.50) C: 38.50 (3.20) → 37.50 (3.20) |
NA | 12 W | SP6 SP10 ST36 LI11 |
| Ruei et al. (37) | RCT | HD | T: 80 C: 70 |
T: 21–73 C: 24–69 |
A (2 times/W or 3 times/2W) + HD | Calcitrol (2 ug two times/W or 3 times/2W) + HD | Conventional Tx |
16 W | NA | NA | NA | T: 71/80 C: 62/80 |
12 M | LI11 ST36 SP6 SP10 |
| Kao et al. (38) | RCT | HD | T: 34 C: 34 |
Total 22~72 (mean 43.6) | A (2 times/W) + HD | Chlorpheniramine + HD | Conventional Tx |
4 W | NA | NA | NA | T: 33/34 C: 24/34 |
NA | LI11 ST36 |
| Auricular acupressure (AA) | ||||||||||||||
| Mai et al. (39) | RCT | HD | T: 40 C: 40 |
T: 45.70 (15.20) C: 44.97 (17.30) |
AA (3 times/d) + HD | HD | Conventional Tx |
4 W | QLQ-C30 (life quality) | Pauli-Magnus scale | T: 25.23 (16.42) → 3.75 (1.42) C: 24.85 (17.67) → 5.65 (1.67) |
NA | NA | Lung Heart Endocrine Lung Heart Endocrine SF1.2i |
| Yan et al. (40) | RCT | HD | T: 32 C: 36 |
T: 57.72 (12.16) C: 61.06 (11.77) |
AA (9 times/2ds) + HD | HD | Conventional Tx |
12 W | Ca, P, PTH, IL-2, IL-6, IL-8, IL-10 | VAS | T: 5.69 (0.97) → 2.66 (0.87) C: 5.75 (0.94) → 4.19 (0.92) |
NA | NA | Kidney Lung Heart Endocrine Subcortical TF4 |
| Chen et al. (41) | RCT | HD | AA+ND: 30 ND: 30 C: 30 |
AA+ND: 44.10 (1.60) ND: 43.90 (1.40) C: 44.20 (1.50) |
ND (3 times/W) AA+ND: AA (3~5 imes/d) + ND |
HD | Conventional Tx |
48 W | Ca, P, PTH, ALP, vitamin D | NA | NA | Itching: AA+ND: 20/30 ND: 8/30 C: 5/30 |
NA | TF4 Kidney Spleen Stomach Subcortical Sympathy |
| Yan et al. (42) | RCT | HD | T: 39 C: 39 |
T: 57.16 (17.01) C: 54.40 (8.37) |
AA (9 times/2ds) + HD | HD | Conventional Tx |
12W | Ca, P, PTH, amylase, histamine, IL-2 | VAS | T: 5.84 (1.82) → 3.88 (1.50) C: 5.84 (2.06) → 5.37 (1.90) |
NA | NA | Kidney Lung Heart Endocrine Subcortical TF4 |
| Ding et al. (43) | RCT | PD | Total: 65 T: – C: – |
T: 60.76 (12.33) C: 64.42 (10.47) |
AA (8 times/2ds) + HD | HD | Conventional Tx |
12 W | Ca, P, PTH, Hb, CRP, histamine, IL-2, IL-6, IL-8, IL-10 | VAS | T: 5.29 (0.97) → 2.24 (0.78) C: 5.42 (1.12) → 4.10 (1.01) |
NA | NA | Kidney Lung Heart Endocrine Subcortical TF4 |
| FIIQ | T: 11.71 (2.34) → 8.18 (1.70) C: 12.81 (2.27) → 10.29 (1.90) |
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| TCM symptom score | T: 34.12 (5.89) → 25.94 (2.93) C: 36.13 (5.32) → 30.32 (4.82) |
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| He et al. (44) | RCT | HD | T: 34 C: 35 |
T: 54.18 (10.76) C: 50.23 (12.69) |
AA (4~5 times/2ds) + HD | HD | Conventional Tx |
4 W | Ca, P, PTH, Cr, BUN, albumin, Hb | Pauli-Magnus scale | Scratching activity T: 2.74 (1.33) → 1.18 (0.39) C: 2.54 (0.85) → 2.14 (0.69) Distribution of pruritus T: 1.94 (0.78) → 1.06 (0.24) C: 1.63 (0.73) → 1.60 (0.60) Awaking from itching T: 1.53 (2.87) → 0.12 (0.48) C: 1.60 (1.80) → 0.86 (1.00) Number of nighttime scratching T: 2.24 (1.52) → 0.65 (0.88) C: 1.83 (1.07) → 1.80 (1.08) |
NA | NA | Lung Endocrine Adrenal |
| VAS | T: 4.59 (2.03) → 1.79 (1.10) C: 3.80 (1.39) → 3.29 (1.13) |
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| Lin et al. (45) | RCT | CKD | Fumigation: 30 AA: 30 Fumigation + AA: 30 C: 30 |
NA | AA (3~5 times/2ds) (Fumigation ingredient: Tufulin, Huangba, Kushen, Machixian, Licorice, Senecio) | Conventional Tx |
Conventional Tx |
8 W | P, PTH | Serjip score | Fumigation: 326 → 116 AA: 325 → 126 Fumigation+AA: 336 → 136 C: 316 → 207 |
NA | NA | Lung Spleen Stomach Adrenal supracortical Sympathy Endocrine Wheel area |
| Li et al. (46) | RCT | HD | T: 40 C: 40 |
T: 53.80 (3.60) C: 55.10 (1.0.80) |
AA (4 times/d) + HD | Acrivastine (8 mg 3 times/d) + HD | Conventional Tx |
4 W | NA | NA | NA | T: 38/40 C: 28/40 |
NA | A: Kidney Heart Lung Liver spleen Sanjio B: Bladder SHENMEN HX1 HX6.7i SF1.2i AT2.3.4i |
| Tao et al. (47) | RCT | HD | T: 40 C: 40 |
T: 55.90 (3.10) C: 56.20 (3.50) |
AA (5~8 times/d) + HD | HD | Conventional Tx |
8~12 W | NA | itching severity, frequency, sleep | T: 19.36 (2.37) → 7.36 (2.18) C: 19.71 (2.33) → 13.27 (2.23) |
NA | NA | Kidney Spleen Stomach Sympathy Subcortical Shenmen (TF4) |
| Yan et al. (12) | RCT | HD | T: 32 C: 30 |
Total 20~65 | AA (5~8 times/d) + HD | Placebo + HD | Conventional Tx |
6 W | Ca, P, PTH, histamine, substance P, PAR-2, tryptase | VAS | T: 5.75 (2.03) → 3.84 (1.69) C: 5.60 (2.13) → 5.57 (2.29) |
NA | NA | Shenmen (TF4), kidney (CO10), lung (CO14), endocrine (CO18), subcortical (AT4) |
| Shr et al. (48) | RCT | HD | T: 30 C1 (HD+HP): 30 C2 (HD): 30 |
Total 58.00 (17.00) | AA (>4 times/d) + HD | HD+HP or HD | Conventional Tx |
4 W | Ca, P, PTH, BUN, β2-MG, Cr | NA | NA | T: 26/29 C1: 23/27 C2: 10/28 |
NA | A: Heart Lung Liver Spleen Sanjiao B: Bladder Shenmen (TF4) |
| Acupoint far infrared (AFIR) | HX1 HX6.7i SF1.2i AT2.3.4i |
|||||||||||||
| Hsu et al. (49) | RCT | HD | T: 21 C: 20 |
T: 57.14 (2.74) C: 66.90 (3.06) |
AFIR (1 time/d, 2 ds/W) | HD | Conventional Tx |
18 W | Ca, P, albumin, Urea, ALK-P, Hb, PTH | Uremic pruritus questionnaire | T: 17.85 (2.33) → 6.43 (0.91) C: 17.55 (2.00) → 9.05 (1.59) |
NA | NA | SP6 |
| VAS | T: 18.57 (1.41) → 10.71 (1.17) C: 16.50 (1.35) → 10.70 (1.03) |
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| Acupoint injection (AI) | ||||||||||||||
| Wang et al. (50) | RCT | HD | T: 55 C: 54 |
T: 56.40 (8.60) C: 56.40 (8.80) |
AI (2 times/W) + Neurotin (0.1 g 2 times/d) + HD | Neurotin + HD | Conventional Tx |
4 W | Ca, P, PTH | VAS | T: 6.43 (1.24) → 3.35 (1.52) C: 6.25 (1.22) → 4.38 (1.19) |
NA | NA | LI11 ST36 |
| DRKS | T: 10.96 (3.40) → 5.46 (2.17) C: 12.16 (9.55) → 7.60 (2.63) |
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| Acupoint injection and acupuncture (AI + acupuncture) | ||||||||||||||
| Deng et al. (51) | RCT | HD | T: 23 C: 23 |
Total 42.73 (3.10) | AI (2 times/W) + acupuncture + cetirizine (10 mg QHS) | HD | Conventional Tx |
12W | NA | NA | NA | T: 22/23 C: 19/23 |
NA | AI + A: LI11 ST36 SP10 |
| Wang et al. (52) | RCT | HD | T: 56 C: 54 |
T: 29~78 C: 25~69 |
AI + acupuncture (2 times/W or 3 times/2 Ws) + HD | Calcitrol (0.25 ug 1 time/d or 1 time/2ds) + HD | Conventional Tx |
12 W | NA | NA | NA | T: 51/56 C: 48/54 |
NA | A: EM40 GB31 LI4 LI11 ST36 SP6 SP9 SP10 AI: BI17 BI23 |
| Acupoint injection + acupoint massage (AI + AM) | ||||||||||||||
| Chen et al. (53) | RCT | HD | T: 30 C: 30 |
T: 49.17 (12.20) C: 49.77 (1.24) |
AI (2~3 times/W) + AM (2~3 times/W) + HD | HD | Conventional Tx |
8 W | NA | VAS | T: 7.50 (1.11) → 5.23 (1.36) C: 7.33 (1.32) → 7.27 (1.36) |
T: 27/30 C: 20/30 |
NA | AI: LI11 ST36 AM: DU14 DU23 EM1 EM2 HT7 GB20 LI4 SP6 SP10 PC4 |
| Acupoint infrared (AIF) | ||||||||||||||
| Yi et al. (9) | RCT | HD | T: 20 C: 20 |
T: 56.37 (4.22) C: 56.89 (4.19) |
AIR (2 times/W) + HD | HD | Conventional Tx |
5 W | Ca, P, PTH, albumin, BUN, Cr, Hb, WBC, Plt, | VAS | T: 7.82 (1.69) → 4.17 (2.86) C: 7.49 (1.30) → 6.02 (2.15) |
NA | NA | LI11 SP6 SP10 |
| Sleep quality score | T: 1.92 (0.78) → 0.72 (0.45) C: 1.88 (0.85) → 1.68 (0.91) |
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| Acupoint massage (AM) | ||||||||||||||
| Chen et al. (54) | RCT | High-flux HD | T: 31 C: 31 |
T: 47.90 (13.40) C: 48.30 (11.20) |
AM (3 times/W) High-flux HD (3 times/W) |
High-flux HD | Conventional Tx |
8 W | P, iPTH, hs-CRP | 12-PSS | T: 18.40 (4.20) → 11.60 (3.20) C: 19.10 (6.30) → 13.80 (3.40) |
NA | NA | LI11 |
| Karjalian et al. (7) | RCT | HD | T: 30 C1 (Placebo massage): 30 C2 (no intervention: 30 |
T: 55.31 (8.88) C1: 52.67 (10.89) C1: 55.00 (11.14) |
AM (3 times/W) | C1 (Placebo massage, 3 times/W) + HD C2 (HD) |
Conventional Tx |
4 W | Ca, P, Na, K, PTH, BUN, Cr, Hb | NRS | T: 8.37 (1.22) → 2.87 (0.90) C1: 7.67 → 6.37 C2: 7.73 → 7.33 |
NA | 5 W | SP6, SP10 ST36 LI11 |
| Akca et al. (14) | RCT | HD | AM: 25 ATENS: 24 C: 25 |
AM: 55.24 (10.13) TEAS: 48.08 (9.05) C: 45.84 (10.40) |
AM (3 times/W) ATENS (3 times/W) |
HD | Conventional Tx |
4 W | NA | VAS | AM: 6.84 (1.70) → 3.36 (2.37) ATENS: 7.37 (1.31) → 3.12 (2.15) C: 6.92 (1.41) → 5.08 (1.55) |
NA | NA | ATENS: LI-11 |
| Jedras et al. (55) | RCT | HD | T: 30 C: 30 |
T: 46.63 (12.41) C: 44.57 (10.71) |
AM (3 times/W) | HD | Conventional Tx |
5 W | NA | frequency, intensity localization, influence on wellbeing questionnaire | T: 8.53 (2.31) → 1.07 (1.91) C: 7.70 (2.30) → 7.57 (2.03) |
NA | 18 W | 140 pressure points (20 each on the head, hands, trunk, legs) |
| Acupoint sticking therapy (AST) | ||||||||||||||
| Jiu et al. (56) | RCT | HD | T1 (HD): 20 T2 (HD+HPF): 20 T3 (HD+HF): 20 C1 (HD): 20 C2 (HD+HPF): 20 C3 (HD+HF): 20 |
T1: 45.20 (1.90) T2: 44.60 (2.00) T3: 45.30 (1.80) C1: 45.30 (2.10) C2: 44.70 (2.70) C3: 45.1 (2.20) |
AST (Difuzi, Tusizi, Mudanpi, and Taoren/2ds) | HD, HPF, HF | Conventional Tx |
12 W | Ca, P, PTH, Hb, BUN, Cr | VAS | T1 vs C1 T1: 5.95 (2.26) → 5.20 (2.49) C1: 6.65 (1.57) → 5.05 (1.64) T2 vs C2 T2: 6.85 (1.56) → 3.20 (1.08) C2: 6.40 (1.78) → 3.75 (1.12) T3 vs C3 T3: 6.90 (1.80) → 1.80 (2.03) C3: 5.85 (1.89) → 2.30 (2.03) |
NA | NA | Umbilicus |
| Transcutaneous electrical acupoint stimulation (TEAS) | ||||||||||||||
| Akca et al. (14) | RCT | HD | AM: 25 TEAS: 24 C: 25 |
AM: 55.24 (10.13) ATENS: 48.08 (9.05) C: 45.84 (10.40) |
AM (3 times/W) ATENS (3 times/W) |
HD | Conventional Tx |
4 W | NA | VAS | AM: 6.84 (1.70) → 3.36 (2.37) ATENS: 7.37 (1.31) → 3.12 (2.15) C: 6.92 (1.41) → 5.08 (1.55) |
NA | NA | ATENS: LI-11 |
RCT, randomized controlled trial; T, treatment group; C, control group; Tx, treatment; NA, not applicable; HD, hemodialysis; HDF, hemodiafiltration; HF, hemofiltration; HP, hemoperfusion; ND, nocturnal dialysis; AA, auricular acupressure; ATENS, Acupoint transcutaneous electrical nerve stimulation; W, week; d, day; 5DIS, 5-D itch scale; VAS, visual analog scale; DRKS, Dirk R. Kuypers scale; TCM syndrome score, traditional Chinese medicine syndrome score; PSQI, Pittsburgh Sleep Quality Index; 12-PSS, 12-Item Pruritus Severity Scale; PS, performance status.
Δ
Difference between two numbers.
†
Median (interquartile range).