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Pruritus common among patients with non-dialysis CKD and associated with poor quality of life
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Patients with non-dialysis CKD had a high prevalence of pruritus, which contributed to poor health-related quality of life and increased symptoms of depression and restless sleep, according to a recently published study.
“This research gives us a uniquely international look at how important it is to ask our patients with chronic kidney disease if and how they are affected by pruritus,” Nidhi Sukul, MD, of the division of nephrology in the department of internal medicine at the University of Michigan, told Healio/Nephrology. “It is important to recognize that pruritus is often overlooked by health care providers. Research has shown that in dialysis facilities where 21% to 50% of patients reported having severe pruritus, only 1% of medical directors estimated this same prevalence. This may be due, in part, to under-reporting by patients, as 17% of patients who were 'nearly always' or 'always' bothered by pruritus had not reported their symptoms to any health care provider.”
To evaluate the prevalence of pruritus in patients with CKD who were not on dialysis — along with associated factors and patient-reported outcomes — researchers collected data on the impact of pruritus from adults in Brazil, the United States and France who had stage 3, 4 or 5 CKD (eGFR 60 mL/min/1.73 m2) and who completed patient questionnaires in the CKD Outcomes and Practice Patterns Study. The questionnaire assessed health measures regarding CKD symptoms, health-related quality of life and depression symptoms, allowing participants to also indicate how much they were bothered by pruritus through responses ranging from “not at all” to “extremely.”
Researchers examined associations of moderate to extreme pruritus with patient characteristics, CKD stage, self-reported depression symptoms and restless sleep. In addition, mixed linear regression was used to examine associations between pruritus and physical and mental component summary, with lower scores indicating poorer quality of life.
Researchers found the prevalence of pruritus in the study population was 24% and it was more likely to occur in older patients, women and those with stage 5 CKD, lung disease, diabetes and depression.
It was also observed that patients with moderate pruritus had physical and mental component summary scores of 3.5 and 2.3 points lower than patients without pruritus, while also having a higher adjusted prevalence of patient-reported depression (prevalence ratio = 1.83) and restless sleep (prevalence ratio = 1.69).
Furthermore, researchers noted that these patient-reported outcomes were progressively worse with increasing severity of pruritus.
"The poorer mental and physical health, self-reported depressive symptoms and self-reported restless sleep among patients with pruritus underscores the importance of discovering effective therapies to help alleviate this symptom," Sukul said.“There has been promising research with medications such as gabapentin, pregabalin, and nalfurafine, but more work is needed in this realm, especially for patients who do not respond to these medications.” – by Melissa J. Webb
Disclosures: Sukul reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosure.
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Sukul N, et al. Clin J Am Soc Nephrol. 2019;doi:10.2215/CJN.09600818.
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