Usefulness of the Japanese version of the 5-D itch scale for rating pruritus experienced by patients undergoing hemodialysis

Abstract

Background: Pruritus in patients undergoing hemodialysis reduces quality of life via insomnia and depression, and negatively affects prognosis. For diagnosing pruritus, selecting therapeutic strategies, and determining therapeutic outcomes, methods are needed for objectively quantifying the degree of itchiness. In 2015, the Japanese version of the 5-D itch scale (5D-J), originally developed in the USA in 2010, was developed as a simple self-administered questionnaire; it evaluated the degree of itchiness based on five components: (1) duration of itchiness, (2) degree of itchiness, (3) direction of itchiness, (4) disability caused by itchiness, and (5) distribution of itchiness. 5D-J is useful for comprehensively assessing multiple elements related to itchiness. We used 5D-J to assess the degree of itchiness experienced by patients undergoing hemodialysis to investigate its clinical usefulness. Methods: Subjects were 336 patients undergoing maintenance hemodialysis at our facility in October 2016; they were selected from 383 patients, of whom 20 were excluded because their itchiness had a dermatologic origin and 27 were excluded because their localized itchiness was related to vascular access, respectively. The status of itchiness (duration, degree, direction, disability, and distribution) of the patients was surveyed in October 2016 using 5D-J; total scores were calculated and used for assessing the itchiness experienced by patients. We additionally investigated whether 5D-J scores correlated with visual analog scale (VAS) and Shiratori severity scores for pruritus. Results: Degree was reported as "not present" by 124 patients (36.9%), "mild" by 164 (48.8%), "moderate" by 46 (13.7%), "severe" by 2 (0.6%), and "unbearable" by 0 (0%). Total score was 5 points in 55 patients (16.4%), 6-9 in 176 (52.4%), 10-14 in 95 (28.3%), 15-19 in 9 (2.7%), 20-24 in 1 (0.3%), and 25 in 0 (0%). The 5D-J total and VAS scores were strongly correlated (r = 0.7159; p < 0.001). The 5D-J total score correlated with "daytime itchiness" (r = 0.6441; p < 0.001) and "nighttime itchiness" (r = 0.6352; p < 0.001) on the Shiratori severity score. Conclusions: 5D-J may be useful for objectively assessing itchiness experienced by patients undergoing hemodialysis.

Sleep disturbance among Malaysian patients with end-stage renal disease with pruritus

“…However, the majority (86.3%) reported that their pruritus was mild. Our findings differed from previous studies which reported prevalence rates of mild pruritus as 48.8% in Japan [ 35 ], 22.2% in Egypt [ 36 ], and 41.7% in Saudi Arabia [ 37 ]. In our setting, only high-flux dialyzers were used, and studies have shown that high-flux dialyzers efficiently remove average-sized molecules associated with the aggravation of pruritus better than low-flux dialyzers [ 38 ].…”

Serum thymus and activation-regulated chemokine level is associated with the severity of chronic kidney disease-associated pruritus in patients undergoing peritoneal dialysis

“…The VAS score was almost comparable with the previous studies, 5,13,27 whereas 5D-J showed that our patients appeared to have the same or higher total score and more frequent complaints of pruritus on the abdomen than patients with HD. 25 Our results revealed that higher serum TARC level was significantly correlated with both VAS and 5D-J score and was an independent predictor of them even after adjusting for confounding factors. Although eosinophil count positively correlated with both VAS and 5D-J scores, multivariate analysis did not show a significant association with them.…”

“…23 In addition, the Japanese version of the 5-D itch scale (5D-J) was used for evaluating pruritus-related QOL. 24,25 The 5D-J comprises five components (degree, duration, direction, disability and distribution), and its total scores range from 5 to 25, with higher scores indicating worse pruritus-related QOL. In the component of distribution, all the body sites where pruritus has been present over 2 weeks were recorded for each participant, including the head/scalp, face, chest, abdomen, back, buttocks, thighs, lower legs, tops of feet/toes, soles, palms, tops of hands/fingers, forearms, upper arms, points of contact with clothing or groin.…”

Reliability and validity of the Persian version of 5-D itching scale among patients with chronic kidney disease

“…The original version of the scale reported the internal consistency as 0.73 [ 9 ]. The Japanese version of the scale did not report the internal consistency [ 23 ]. In line with Urdu (ICC= 0.91), Arabic (ICC=0.85), and the original version (ICC=0.96), the Persian version of the 5-D scale showed excellent test-retest reliability.…”

“…The Indonesian version had a strong correlation with the dermatology life quality index and the VAS [ 20 ]. The Japanese version of the scale showed strong correlation with vas ( r =0.70), daytime itchiness ( r =0.64), and nighttime itchiness ( r =0.63) [ 23 ]. Other versions of the scale did not evaluate the correlation of the scale with other related instruments.…”