Self-reported Pruritus and Clinical, Dialysis-Related, and Patient-Reported Outcomes in Hemodialysis Patients

Abstract

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Novel approach to unpleasant symptom clusters surrounding pruritus in patients with chronic kidney disease and on dialysis therapy

“…Although the prevalence estimates of CKD-aP in dialysis patients vary between epidemiological studies, patient-reported data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) indicate that approximately two-thirds of hemodialysis patients have CKD-aP, 37% of which experience moderate-to-severe symptoms [ 6 ▪ ]. Despite its high prevalence, CKD-aP is overlooked by healthcare professionals and under-reported by patients in clinical practice; 17% of patients always or nearly always bothered by itch do not report their symptoms to anyone [ 5 , 11 ].…”

“…CKD-aP is unpleasant and potentially debilitating for patients undergoing hemodialysis, and has been associated with worse clinical outcomes, including a greater risk of infection, hospitalizations, and mortality [ 6 ▪ , 23 ]. Data from DOPPS also showed that hemodialysis patients with extreme pruritus were more likely to withdraw from dialysis, miss scheduled dialysis sessions, and take a longer time to recover from dialysis treatment, compared with patients not bothered by pruritus [ 6 ▪ ].…”

“…CKD-aP is unpleasant and potentially debilitating for patients undergoing hemodialysis, and has been associated with worse clinical outcomes, including a greater risk of infection, hospitalizations, and mortality [ 6 ▪ , 23 ]. Data from DOPPS also showed that hemodialysis patients with extreme pruritus were more likely to withdraw from dialysis, miss scheduled dialysis sessions, and take a longer time to recover from dialysis treatment, compared with patients not bothered by pruritus [ 6 ▪ ]. Similarly, a large retrospective cohort study of US hemodialysis patients ( n = 38,315) also observed a higher number of missed hemodialysis sessions, as well as increased medication use (intravenous [IV] antibiotics, erythropoietin-stimulating agents, and IV iron) among patients who self-reported severe pruritus as compared to those who were not bothered by pruritus [ 24 ].…”

“…Figure 1 provides an overview of patient-reported outcome instruments used to capture CKD-aP HRQoL, with validated measures described in Table 1 . Among the largest epidemiological studies was a recent analysis of the international DOPPS patient cohort (Phases 4–6; 2009–2018) that included >23,000 hemodialysis patients from 21 countries, which evaluated the relationship between pruritus severity and patient-reported outcomes [ 6 ▪ ]. Itch intensity was assessed using the itch question from the self-reported Kidney Disease Quality of Life 36-item short-form survey (KDQOL-36), which asks patients the extent to which they were bothered by itchy skin during the past 4 weeks (5-category scale: ‘not at all’ to ‘extremely’).…”

“…Hence, the proactive identification and alleviation of symptoms are critical to the holistic management of these individuals. CKD-associated pruritus (CKD-aP; previously known as uremic pruritus) is a frequent and burdensome symptom reported by patients with CKD, and often worsens as CKD progresses to ESKD requiring renal replacement therapy [ 5 , 6 ▪ ].…”