Uremic pruritus and long-term morbidities in the dialysis population

Abstract

Background Uremic pruritus (UP) is a multifactorial problem that contributes to low quality of life in dialysis patients. The long-term influences of UP on dialysis patients are still poorly understood. This study aims to elucidate the contribution of UP to long-term outcomes. Materials and method We used the Taiwan National Health Insurance Research Database to conduct this study. Patients on chronic dialysis were included and divided into UP and non-UP groups according to the long-term prescription of antihistamine in the absence of other indications. The outcomes include infection-related hospitalization, catheter-related infection, major adverse cardiac and cerebrovascular events (MACCE) and parathyroidectomy. Results After propensity score matching, 14,760 patients with UP and 29,520 patients without UP were eligible for analysis. After a mean follow-up of 5 years, we found that infection-related hospitalization, MACCE, catheter-related infection, heart failure and parathyroidectomy were all slightly higher in the UP than non-UP group (hazard ratio: 1.18 [1.16–1.21], 1.05 [1.01–1.09], 1.16 [1.12–1.21], 1.08 [1.01–1.16] and 1.10 [1.01–1.20], respectively). Subgroup analysis revealed that the increased risk of adverse events by UP was generally more apparent in younger patients and patients who underwent peritoneal dialysis. Conclusion UP may be significantly associated with an increased risk of long-term morbidities.

Mucocutaneous manifestations of patients with chronic kidney disease under hemodialysis: A cross‐sectional study of 49 patients

“…Uremic pruritus is a multifactorial skin manifestation of ESRD and hemodialysis that affects the patients' living standards significantly 19 …”

Epidemiology and burden of chronic kidney disease-associated pruritus

“…Other studies support the link between CKD-aP and cardiovascular mortality. Ting et al [ 9 ] showed a slight increase in major cardiovascular adverse events (HR 1.05) and heart failure (HR 1.08) and Weng et al [ 40 ] found that CKD-aP was a predictor for 2-year cardiovascular mortality in HD patients (HR 3.164).…”

“…Dialysis patients with itch are reported to have increased infection-related events, including sepsis and bacteraemia [ 9 ]. Sukul et al [ 8 ] found an increased risk of skin-related infections in HD patients with extreme itch (HR 1.41).…”

“…Sukul et al [ 8 ] found an increased risk of skin-related infections in HD patients with extreme itch (HR 1.41). Ting et al [ 9 ] conducted a large study on 14 760 dialysis patients with CKD-aP and found increased infection-related hospitalization (HR 1.13) and catheter-associated infection (HR 1.16) compared with a control group of dialysis patients without pruritus [ 9 ]. A large retrospective cohort study in 73 124 patients with ESKD found that increased IV antibiotic use was also associated with greater itch severity in HD patients, particularly those dialysing via a central venous catheter (CVC) [ 16 ].…”

Chronic Kidney Disease-Associated Pruritus: A Glance at Novel and Lesser-Known Treatments

“…A meta-analysis of several observational studies has reported a prevalence of at least 50% in patients on dialysis [1]. CKD-aP is more than just an irritating itch; in fact, it has far-reaching effects and has been associated with increased morbidity and mortality and decreased quality of life [2][3][4]. CKD-aP affects patients on hemodialysis and peritoneal dialysis to a similar degree; however, a study on the topic has found that it affected patients on hemodialysis to a lesser extent [1,5].…”