Severity of CKD-associated pruritus linked to all-cause mortality, other comorbidities
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Key takeaways:
- During the study, 51% of patients reported being bothered by pruritus.
- Patients extremely bothered by the condition had a higher risk for all-cause mortality.
The severity of chronic kidney disease-associated pruritus may be linked with higher risks of all-cause mortality, hospitalizations, cardiovascular events and infections, data show.
“Itching is a common symptom of CKD that can significantly affect an individual’s quality of life,” Jennifer S. Scherer, MD, of the divisions of palliative care and nephology at the NYU School of Medicine, and colleagues wrote in a study. “Although the discomfort associated with [CKD-associated pruritus] CKD-aP can be significant, it is often underreported by patients and underrecognized by providers. This lack of identification can lead to challenges in studying its impact and treatment.”
In an international longitudinal cohort study that included 4,410 adults from 91 clinics in Brazil, France and the United States, researchers tested the relationships between CKD-aP and various clinical outcomes.
Patients with nondialysis dependent-CKD and median eGFR below 60 mL/min/1.73 m2, who were enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study from 2013 to 2021, were included. Median age was 69 years.
Participants self-reported CKD-aP based on the severity of itch during 4 weeks. Outcomes included CKD progression, the start of kidney replacement therapy, mortality, hospitalization, cardiovascular events and infection events.
Scherer and colleagues found 51% of patients reported being bothered by pruritus. Proportionally, 49% were “not at all” bothered, 27% were “somewhat,” 13% were “moderately,” 7% were “very much” and 3% were “extremely” bothered by the condition. Patients with more advanced stages of CKD, older age and more comorbidities had a higher prevalence of CKD-aP.
Of those at least moderately bothered, 23% were prescribed pharmacotherapy, including antihistamines, gabapentin, topical corticosteroids, pregabalin or sedating antihistamines.
Severity of CKD-aP was not associated with CKD progression or the initiation of kidney replacement therapy, according to the study. There was a link between CKD-aP severity and clinical outcomes. Patients extremely bothered had a higher risk for all-cause mortality, hospitalizations and cardiovascular events compared with those who were not.
“These data, along with the patient-reported outcomes already known, can increase awareness of CKD-aP, its complications and treatment,” the researchers wrote. The findings “provide clinicians with more information to convey to people with CKD about their disease, yet also expose gaps in the current understanding of CKD-aP and options for treatment, all warranting further investigation.”
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