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

Abstract

Purpose of review Chronic kidney disease-associated-pruritus (CKD-aP) is a common symptom in patients with end-stage kidney disease (ESKD) undergoing dialysis. CKD-aP typically occurs alongside other debilitating symptoms and may comprise so-called ‘symptom clusters’ which have synergistic effects that adversely impact patient health-related quality of life (HRQoL). Importantly, symptoms in a cluster may share a common biological mechanism. Here we review the clinical impact of CKD-aP and its association with other symptoms reported by dialysis patients. The clinical benefits of treating pruritus and its potential impact on other symptoms are also addressed. Recent findings Studies have shown CKD-aP significantly impairs HRQoL in patients with ESKD undergoing dialysis and is associated with adverse clinical outcomes, including increased risk of infections, hospitalizations, and mortality. Despite these negative effects, CKD-aP remains underrecognized and undertreated in clinical practice. CKD-aP is frequently associated with other symptoms, including disturbed sleep/poor sleep quality, anxiety, depression, and pain. Clinical studies of antipruritic therapies show that reduction of itch intensity may also alleviate other associated symptoms, such as poor sleep quality. Summary CKD-aP and its associated symptoms are inadequately managed in clinical practice. Greater understanding and awareness of CKD-aP and its surrounding symptom clusters in dialysis patients may improve their overall symptom management and HRQoL.

Patient-centred approaches for the management of unpleasant symptoms in kidney disease

“…For instance, inability to sleep well, fatigue and depression can be caused or aggravated by pruritus. A lead symptom can result in additional unpleasant symptoms in the form of symptom clusters; for example, chronic or recurrent pruritus causes or intensifies other symptoms 38,39 .…”

Living Well With Kidney Disease and Effective Symptom Management: Consensus Conference Proceedings

“…25 In people with end-stage kidney disease (ESKD), itching has been shown to co-occur with other symptoms such as anxiety or stress, depression, fatigue, pain, feeling washed out after hemodialysis, restless legs syndrome, and sleep disturbances, and these symptoms may comprise a symptom cluster. 26 Fatigue is common across the spectrum of kidney disease, 27 is debilitating for people with CKD, 28 and most people with itching suffer from disturbed or restless sleep. 12,17 Fatigue, sexual symptoms (such as reduced interest in sex and inability to become aroused), and restless legs were identified as major driving symptoms in a symptom cluster in a study of people with advanced CKD.…”

Alleviating symptoms in patients undergoing long-term hemodialysis: a focus on chronic kidney disease-associated pruritus

“…CKD-aP frequently co-occurs with other physical and psycho-emotional symptoms experienced by HD patients, including poor sleep quality, depression, fatigue and pain [ 17–19 ], which together represent an important symptom cluster that is inadequately managed in clinical practice [ 20 ].…”