Chronic Kidney Disease-Associated Pruritus Burden: A Patient Survey Study

Abstract

Rationale & Objective

Chronic kidney disease-associated pruritus (CKD-aP) is a common, underrecognized condition in patients with chronic kidney disease (CKD), especially those receiving hemodialysis (HD). The present study analyzed the clinical treatment journey and overall burden of pruritus among patients with CKD-aP.

Study Design

Cross-sectional, patient-reported online survey.

Setting & Participants

Data from adult patients undergoing HD (December 2021–May 2022) in the United States.

Exposure

Patients participated in an online survey and responded to questions on validated patient-reported outcome instruments related to CKD-aP.

Outcomes

Self-reported measures analyzed at the end of this survey include itch characteristics; symptom management; health care provider (HCP) engagement; and effect on HD, quality of life (QoL), sleep, and work productivity.

Analytical Approach

Bivariate analysis assessed the association of itch severity with CKD-specific QoL.

Results

Overall, 354 patients with CKD-aP were included in analyses, of which 49% and 30% had moderate and severe itch, respectively (22% were mild). Around 68% reported symptoms to HCPs, most commonly a nephrologist or primary care provider, and 55% received a treatment recommendation. The most common treatments were topical lotions/moisturizers (75%) and corticosteroids (48%); use of oral prescriptions was low (20%), with limited satisfaction with treatments. Overall, 23% of patients reported shortening and 17% reported missing HD sessions because of itch. In bivariate analysis, patients with more severe CKD-aP reported significantly worse disease and function scores (kidney disease score, cognitive function, quality of social interaction, sleep [all, P < 0.001], and sexual function [P < 0.05]), suggesting a direct effect of CKD-aP on QoL.

Limitations

Possible recall bias, especially for questions with longer recall periods.

Conclusions

CKD-aP is often inadequately treated and disruptive of dialysis treatment, even among patients who report itch to HCPs. Worse itch severity is associated with poorer QoL, sleep quality, and functional/work impairment.

Plain-Language Summary

Chronic kidney disease-associated pruritus (CKD-aP) is a common problem in patients with kidney disease, especially in those who are receiving dialysis. There are few approved treatment options for CKD-aP. Understanding how CKD-related itch affects patients may help identify ways to improve CKD-aP symptoms/signs. This patient-reported survey assessed itch characteristics, symptom management attempts and effectiveness, and burdens caused by itch in patients with CKD-aP. Although >60% of hemodialysis patients reported having itch-related symptoms, CKD-aP may be underdiagnosed. Most patients reported that they were not given treatment options and/or were not satisfied with their current treatments. The study also showed that itch intensity affected patient's full participation in prescribed dialysis sessions, quality of life, quality of sleep, and work productivity.