Pruritus in patients on maintenance hemodialysis is chronic, may reduce quality of life
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Key takeaways:
- More than half of patients had moderate to severe chronic kidney disease-associated pruritus during the study period.
- Patients with incident pruritus had increase in depression, restless sleep and fatigue.
Moderate to severe pruritus remains a chronic problem in patients on maintenance hemodialysis that can reduce overall quality of life, according to recently published data.
Investigators led by Nidhi Sukul, MD, assistant chief of the renal section at the Veterans Affairs Ann Arbor Health Care System and an assistant professor in the division of nephrology at the University of Michigan, studied the “prevalence of pruritus and medication ... to evaluate the association between change in [chronic kidney disease-associated pruritus] CKD-aP and concurrent change in laboratory values and [patient-reported outcomes],” they wrote in the study.
The prospective cohort Dialysis Outcomes and Practice Patterns Study (DOPPS) involved 7,976 patients on hemodialysis from 2009 to 2018 and who were located across 21 countries in DOPPS phases 4 to 6. Patients had two CKD-aP assessments approximately 12 months apart.
Researchers assessed pruritis exposure at the beginning of the study and 1 year later. Using a linear mixed model, they examined changes in lab values and patient-reported outcomes during the study across four exposure groups: resolved, incident, absent and persistent.
Researchers found 51% of patients experienced moderate to severe CKD-aP at either assessment, with 22% having symptoms at both evaluations. Among patients with pruritus at baseline, 50% reported itching persisted for more than 1 year. Patients with incident pruritus exhibited an uptick in depression, restless sleep and fatigue and were more likely to report low quality of life, while those with resolved pruritus had decreases in these outcomes. Researchers observed minimal changes in patient-reported outcomes for the absent and persistent groups. Changes in laboratory values were not detected for either group. Additionally, compared to patients without CKD-aP, patients with persistent CKD-aP had higher adjusted hazard ratios for all-cause mortality, all-cause hospitalization and cardiovascular events.
“In conclusion, at least half of chronic [hemodialysis] HD patients were affected by CKD-aP over the course of 1 year, and symptoms remained unresolved 12 months later for the majority of HD patients bothered by itchy skin at baseline,” Sukul and colleagues wrote.
Reference:
- Chronic itching worsens fatigue and reduces quality of life in 50% of hemodialysis patients. https://www.kidney.org/news/chronic-itching-worsens-fatigue-and-reduces-quality-life-50-hemodialysis-patients#:~:text=National%20Kidney%20Foundation-,Chronic%20Itching%20Worsens%20Fatigue%20and%20Reduces%20Quality,in%2050%25%20of%20Hemodialysis%20Patients&text=(Aug.,among%20patients%20receiving%20maintenance%20hemodialysis. Published Aug. 16, 2023. Accessed Aug. 22, 2023.
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