Pruritus and Patient Reported Outcomes in Non-Dialysis CKD

Abstract

Background and objectivesAmong patients on hemodialysis, pruritus has been associated with poorer mental and physical quality of life, sleep quality, depression, and mortality. We evaluated patients with nondialysis CKD to describe the prevalence of pruritus, identify associated factors, and investigate associations with patient-reported outcomes.Design, setting, participants, & measurementsUsing cross-sectional data from patient questionnaires in the CKD Outcomes and Practice Patterns Study (CKDopps), we asked patients with CKD stages 3–5 (nondialysis) from the United States, Brazil, and France to identify how much they were bothered by pruritus. Response options ranged from “not at all” to “extremely.” Log-Poisson regression, yielding prevalence ratios, was used to evaluate associations of moderate-to-extreme pruritus with patient characteristics, CKD stage, self-reported depression symptoms, and restless sleep. Mixed linear regression was used to examine associations between pruritus and physical and mental component summary scores, with lower scores indicating poorer quality of life.ResultsOf the 5658 CKDopps patients enrolled in the United States, Brazil, and France, 3780 (67%) answered the pruritus question. The prevalence of moderate-to-extreme pruritus was 24%, and more likely in older patients, women, and those with stage 5 CKD, lung disease, diabetes, and physician-diagnosed depression. In adjusted models, patients with moderate pruritus had physical and mental component summary scores 3.5 (95% confidence interval [95% CI], −4.6 to −2.3) and 2.3 (95% CI, −3.2 to −1.5) points lower, respectively, than patients without pruritus, and they also had a higher adjusted prevalence of patient-reported depression (prevalence ratio, 1.83; 95% CI, 1.58 to 2.11) and restless sleep (prevalence ratio, 1.69; 95% CI, 1.49 to 1.91) compared with patients without pruritus. These patient-reported outcomes were progressively worse with increasing severity of pruritus.ConclusionsOur findings demonstrate high prevalence of pruritus in nondialysis CKD, as well as strong associations of pruritus with poor health-related quality of life, self-reported depression symptoms, and self-reported poor sleep.

CKD-Associated Pruritus: New Insights Into Diagnosis, Pathogenesis, and Management

“…The largest study of CKD-aP prevalence in patients with CKD, not yet on dialysis, comes from the CKD Outcomes and Practice Patterns Study (CKDopps). 7 CKDopps is an international, prospective, nephrology clinic-based cohort study of 5658 adult patients with stage 3-5 CKD (nondialysis) from the US, Brazil, and France. Demographic data, comorbid conditions, labs, medications, KDQOL-SF, and CES-D-short form are collected.…”

“…In a recent study of CKD-aP prevalence from this database, 67% of patients completed relevant survey data. 7 The studied population included 15% with stage 3a, 34% with stage 3b, 44% with stage 4, and 7% with stage-5 CKD. The prevalence of at least moderate pruritus was 24% (24% in Brazil, 29% in the US, and 23% in France), and of severe to extreme pruritus was 11% in Brazil, 13% in the US, and 10% in France.…”

“…36 Furthermore, in patients with CKD, not yet on dialysis, only 10% with moderate to extreme pruritus were being prescribed medications for itching. 7 When dialysis medical directors do treat severe pruritus, they consider phosphorus control as the most important treatment, followed by increasing dialysis dose in patients with low Kt/V, increasing prescribed time in patients with short treatments, and lowering PTH levels when elevated. Prescribing medications was ranked the least important intervention.…”

Cutaneous Biophysical Parameters in Different Stages of Chronic Kidney Disease and the Relationship with Water Content and Severity of Pruritus

“…Chronic kidney disease (CKD) is associated with various cutaneous manifestations including pruritus, xerosis, pigmentation, yellow skin, perforating disorders, calciphylaxis, benign nodular calcification, porphyria cutanea tarda, pseudoporphyria, and nephrogenic systemic fibrosis (1)(2)(3). The most common manifestation, xerosis affects 66% to 72% (1,2), while pruritus affects 24% to 43% patients (1,2,4). Pruritus and xerosis often co-exist.…”

Frailty and sarcopenia in elderly non-dialysis patients with chronic kidney disease stage 3-5: a cross sectional study

“…Non-dialysis patients with CKD stage 3-5 account for a relatively high proportion, the research and early intervention of these patients may reverse the progression to end-stage renal disease, thus, it has important clinical signi cance. The general clinical characteristics of non-dialysis patients have been widely studied [6][7][8]. However, to the best of our knowledge, there are few studies on the analysis of sarcopenia in non-dialysis patients with CKD stage 3-5.…”