Epidemiology and burden of chronic kidney disease-associated pruritus

Abstract

Chronic kidney disease–associated pruritus (CKD-aP) is a common, yet underrecognized condition in patients with CKD and end-stage kidney disease (ESKD). Real-world observational studies indicate that CKD-aP affects up to 80% of ESKD patients undergoing haemodialysis (HD), with ∼40% experiencing moderate to severe itch. CKD-aP can negatively impact patients’ mental and physical health-related quality of life (HRQoL) and is also associated with sleep disturbance and depression. Several studies have found that CKD-aP is a predictor of adverse medical outcomes, including an increased risk of hospitalizations and mortality. In this article we review the literature relating to the epidemiology of CKD-aP to describe its prevalence across the treatment spectrum of CKD (non-dialysis, HD, peritoneal dialysis and transplant recipients) and to summarize potential risk factors associated with its development. We also review key data from studies that have evaluated the impact of CKD-aP on HRQoL and medical outcomes.

Epidemiology of peritoneal dialysis outcomes

“…More than half of all patients receiving PD (52.1–62.6%) experience pruritus 147 , 148 , which is characterized by an itching sensation with variable spatial distribution (usually affecting large, discontinuous areas of skin) and without evident skin alterations that is exacerbated at night 149 . Pruritus is associated with impaired QOL domains, particularly sleep, mood and social functioning 150 , and increased risks of death and HD transfer 151 . Although the pathogenesis of pruritus remains largely unknown, it is no longer thought to be purely histamine-mediated but rather to result from a complex crosstalk between dermal mast cells, epidermal keratinocytes, T helper 1 lymphocytes and nerve fibres 152 .…”

Difelikefalin: A New κ-Opioid Receptor Agonist for the Treatment of Hemodialysis-Dependent Chronic Kidney Disease–Associated Pruritus

“…2,4,5 Rates of moderate-to-severe CKD-aP are estimated between 20% and 40%, with decreasing prevalence as HD efficiency improves. 2,4,5 HD efficiency as measured by Kt / V , a metric of how much urea is removed during an HD session, has been correlated with severity of pruritus where low Kt / V values are indicative of increased pruritus. 5 CKD-aP has a variable presentation, with half of patients experiencing diffuse itch and others with localized itch, predominantly on the back or the fistula arm.…”

“…5 CKD-aP has a variable presentation, with half of patients experiencing diffuse itch and others with localized itch, predominantly on the back or the fistula arm. 2 The most common abnormal skin finding, xerosis, may be present in up to 85% of patients. 2 CKD-aP can impact a patient’s quality of life (QOL), affect their sleep quality, and can result in a 22% increase in mortality among patients with moderate-to-severe CKD-aP.…”

“…However, the term CKD-aP is now preferred as the degree of uremia may not always correlate with the degree of pruritus. 2,6 Patients with CKD-aP have a higher prevalence of neuropathy than other CKD patients, potentially implicating afferent sensory nerves as a source of the itching. 7 A decrease in KORs has been shown within the skin of CKD-aP patients which supports a potential role of the KOR in treatment.…”

“…1 CKD-aP, formerly known as uremic pruritus, is a condition of itch lasting greater than 6 weeks in a chronic kidney disease (CKD) patient without alternate causes. 2,3 Due to lack of awareness, underdiagnosis of CKD-aP is a concern, and incidence in studies is widely varied ranging between 18% and 80%. 2,4,5 Rates of moderate-to-severe CKD-aP are estimated between 20% and 40%, with decreasing prevalence as HD efficiency improves.…”