CKD-associated pruritus outcomes in people receiving dialysis

Pruritus, a strong sensation of itching, is a burdensome uraemic symptom commonly experienced by people with advanced chronic kidney disease (CKD). Itching can range from sporadic discomfort to complete restlessness that significantly impacts quality of life. It has been self-reported by about 40% of people undergoing maintenance dialysis, but is not well-characterised.

The present observational study aimed to quantify the burden of pruritus and its associated adverse health outcomes in a population receiving maintenance dialysis. It included all patients in the Stockholm CREAtinine Measurement (SCREAM) cohort who were initiating or undergoing either haemodialysis (HD) or peritoneal dialysis (PD) from 2005–2021. 

Data from 3281 dialysis patients (77% of whom had been on dialysis for <1 year) was analysed. The median age was 64 years, 66% were men and 69% were on HD. At enrolment, 456 (13.9%) had clinically recognised pruritus (14.8% of patients on HD and 12.0% of patients on PD). During a median follow-up of 3.3 years, an additional 539 (19.1%) of those free of pruritus at baseline (21.2% of patients on HD and 14.4% of patients on PD) developed it.

There was consistency between the clinical determinants of prevalent and new-onset pruritus. Pruritus was more common with older age, female sex, higher levels of C-reactive protein, serum calcium and phosphate, and lower levels of serum albumin.

During follow-up, 1532 deaths, 949 infection-related hospitalisations, 328 new cases of anxiety or depression and 485 new cases of sleep disorders were recorded. Compared to those without pruritus, patients with the condition were at a higher risk of developing anxiety/depression (aHR, 1.56 [95% CI, 1.23–1.98]) and sleep disorders (aHR, 1.96 [1.60–2.39]). Pruritus was also associated with the risk of severe infections (aHR, 1.36 [1.18–1.57], mainly attributable to a higher risk of sepsis and PD-related peritonitis. There was no association between pruritus and all-cause mortality.

This study illustrates how common clinically recognised pruritus is in people on dialysis, with at least one third of patients experiencing it during their first years of therapy, and its association with adverse health outcomes. These findings may inform clinical decisions for periodic screening for pruritus, particularly in high-risk populations.  

The full article can be read here.