Itching in dialysis patients: impact on health-related quality of life and interactions with sleep problems and psychological symptoms—results from the RENINE/PROMs registry

Abstract

Background Itching (pruritus) is common in dialysis patients, but little is known about its impact on health-related quality of life (HRQOL), sleep problems and psychological symptoms. This study investigates the impact of itching in dialysis patients by looking into the persistence of itching, the effect of itching on the course of HRQOL, and the combined effect of itching with sleep problems and with psychological symptoms on HRQOL. Methods Data were obtained from the RENINE/PROMs registry and included 2978 dialysis patients who completed patient-reported outcome measures between 2018–2020. Itching, sleep problems and psychological symptoms were assessed with the DSI, and HRQOL with the SF-12. Effects of itching on HRQOL and interactions with sleep problems and psychological symptoms were investigated cross-sectionally and longitudinally, using linear regression and linear mixed models. Results Half of the patients experienced itching and in 70% of them, itching was persistent. Itching was associated with a lower physical and mental HRQOL (-3.35 [95%CI: -4.12; -2.59] and -3.79 [95%CI: -4.56; -3.03]). HRQOL remained stable during two years and trajectories did not differ between patients with or without itching. Sleep problems (70% vs 52%) and psychological symptoms (36% vs 19%) were more common in patients with itching. These symptoms had an additional negative effect on HRQOL, but did not interact with itching. Conclusions The persistence of itching, its impact on HRQOL over time, and the additional effect on HRQOL of sleep problems and psychological symptoms, emphasize the need for recognition and effective treatment of itching to reduce symptom burden and improve HRQOL.

Symptom Burden before and after Dialysis Initiation in Older Patients

“…Second, in contrast, the burden of itch, a classic uremic symptom, did not improve after dialysis initiation. This is in line with previous studies that also found a high burden of itching in patients on dialysis (39,40). This may be partly explained by the fact that dialytic clearance of uremic toxins is limited to the unbound fraction that can diffuse across the dialysis membrane (14,15).…”

Obstacles to Early Diagnosis and Treatment of Pruritus in Patients with Chronic Kidney Disease: Current Perspectives

“…A study of RENINE/PROMs registry data of 2978 Dutch dialysis patients by van der Willik et al revealed that 50% of patients had itching which was described as “persistent itching” by 70% of those 50%. 11 …”

“… 47 An elevated calcium phosphate product and elevated parathyroid hormone level in the group of patients who benefitted from parathyroidectomy suggests that CKD mineral bone disease may be a factor related to CKD-aP. 11 , 12 However the calcium phosphate product is an artificial construct and unlikely to be highly representative in the complex physiology of mineral trafficking and it is highly likely that the subtleties of mineral trafficking have been missed by the crude association of the calcium phosphate product. Nevertheless, there is more calcium in the basal skin layer in patients with CKD-aP and this is an area that needs further research.…”

“…A few risk factors such as white blood cell (WBC) count >6700/µL, or the presence of hepatitis C or ascites associated with severe pruritus identified in the DOPPS study suggest the role of microinflammation. 11 Additionally, significantly raised blood levels of cytokines may play a key role in CKD-aP including Interleukin-31 (IL-31), Interleukin-6 (IL-6), and Interleukin-2 (IL-2) as well as other evidences of immune activation or dysregulation such as raised Th1 lymphocytes or C-reactive protein (CRP). 54 , 55 …”

Glial Cells and Itch: Possible Targets for Novel Antipruritic Therapies

“…Chronic itch generally lasts more than 6 weeks and is often associated with multiple pathological conditions, such as skin diseases, including atopic dermatitis (AD), and other systemic diseases, such as liver and kidney diseases . Chronic itch is a maladaptive and debilitating condition that is accompanied by a host of comorbidities, including depression, insomnia, and anxiety disorders, , which affect the quality of life of millions of patients . In many cases, scratching is not effective in relieving chronic itch. , Moreover, repetitive scratching can lead to skin damage, worsening the itch and leading to further scratching, thereby creating a vicious cycle. − However, effective drugs for the treatment of itch, especially chronic itch in clinical settings, are lacking .…”