Despite being underdiagnosed and underrecognized, CKD-associated pruritus is frequently linked to poor health-related quality of life (HRQoL), decreased dialysis adherence, and increased mortality. The Centers for Medicare & Medicaid Services (CMS) guidelines from 2008 that mandate routine evaluation of HRQoL in hemodialysis patients serve as an example of how increasing HRQoL is a crucial objective in the treatment of patients with kidney failure. Thus, this study was set to describe the correlation between a recognized symptom cluster and pruritus in hemodialysis patients.
Pruritus and the specific symptoms of sleep disruption, sadness, pain, anxiety, and poor energy/fatigue were examined in this retrospective research of adult hemodialysis patients in a sizable US dialysis facility. Electronic medical records were used to collect data from the Patient Health Questionnaire-2 (PHQ-2) and the Kidney Disease Quality of Life 36-Item Short Form Survey (KDQOL-36).
Nearly, 47,477 of the 243,168 people undergoing hemodialysis who completed a KDQOL-36 throughout the research period experienced at least significant pruritus-related distress. Additionally, 33,833 randomly selected people who did not report at least moderate pruritus were included. Increased pruritus severity was substantially (P<0.001) associated with higher KDQOL-36 ratings for each symptom (sleep disruption, sadness, pain, anxiety, and low energy/fatigue).
The KDQOL-36 summary scores showed similar outcomes. The likelihood of depressed symptoms and sleep disruption was shown to be more than five times and 3-times higher, respectively, in cases with extreme pruritus. Additionally, there was an independent correlation between pruritus and depression symptoms as assessed by the PHQ-2. All serum phosphorus concentration subgroups showed a correlation between pruritus and co-occurring symptoms.
Higher levels of pruritus-related discomfort were substantially more likely to cause patients to skip several hemodialysis sessions or have shorter treatment sessions. Overall, these results underline the need of employing screening methods to evaluate pruritic symptoms in hemodialysis populations and justify the addition of pruritus to the current symptom cluster of sleep disruption, pain, depression, anxiety, and low energy/fatigue. Pruritus and CKD-aP should be checked for in individuals with various reasons of decreased HRQoL.
Source:
Malhotra, K., Desai, T., Ficociello, L. H., Arens, H.-J., Lasky, R. A., & Anger, M. S. (2025). Association of chronic kidney disease–associated pruritus with the sleep disturbance, depression, pain, anxiety, low energy/fatigue symptom cluster: A retrospective cohort study. Kidney Medicine, 101162, 101162. https://doi.org/10.1016/j.xkme.2025.101162
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