CKD-associated pruritus in patients on hemodialysis increases stress, depression and fatigue

A recent study published in the American Journal of Kidney Diseases shed light on the link between chronic kidney disease-associated pruritus (CKD-aP) and its impact on patient health outcomes. This study, conducted across 21 countries and involving 7976 patients receiving maintenance hemodialysis, explored the longitudinal associations between changes in CKD-aP and various clinical outcomes.

The study, a part of the Dialysis Outcomes and Practice Patterns Study (DOPPS) in phases 4-6 (2009-2018), involved assessing CKD-aP symptoms in patients approximately 12 months apart. Four distinct groups emerged based on these assessments: those with pruritus only at the initial assessment (resolved), only at the second assessment (incident), at neither assessment (absent), or at both assessments (persistent).

The findings revealed a striking prevalence of moderate to severe CKD-aP symptoms among the participants, with 51% experiencing such symptoms at either assessment, and 22% suffering from persistent pruritus. Notably, patients who developed incident pruritus experienced an increase in depression, restless sleep, and fatigue over the study period, while those with resolved pruritus saw decreases in these symptoms.

Crucially, the study demonstrated that patients with persistent CKD-aP faced significantly higher risks of adverse clinical events. Comparing them to patients without CKD-aP, those with persistent symptoms had adjusted hazard ratios of 1.29 for all-cause mortality, 1.17 for all-cause hospitalization, and 1.48 for cardiovascular events. This underlines the serious impact of CKD-aP on patient health and well-being.

The lack of interim evaluations between the two assessments and potential selection biases among patients lost to follow-up might have influenced the results. Nevertheless, the study's conclusions highlight the chronic nature of CKD-aP symptoms and stress the importance of repeated assessments using standardized methods. This research underscores the significance of recognizing and managing CKD-aP as an integral part of patient care. 

Source:

Sukul, N., Zhao, J., Pisoni, R. L., Walpen, S., Schaufler, T., Asgari, E., Zho, L., Al-Ghonaim, M. A., Nitta, K., Robinson, B. M., & Karaboyas, A. (2023). Pruritus in Hemodialysis Patients: Longitudinal Associations With Clinical and Patient-Reported Outcomes. In American Journal of Kidney Diseases. Elsevier BV. https://doi.org/10.1053/j.ajkd.2023.04.008