Pruritus Predicts Adverse Outcomes in Patients on Dialysis

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Up to half of patients experiencing hemodialysis report moderate to severe pruritus, which is associated with increased rates of adverse outcomes, reports a study in the American Journal of Kidney Diseases.

The prospective cohort study included 7976 patients from 21 countries enrolled in the Dialysis Outcomes and Practice Patterns Study between 2009 and 2018. Participants underwent two assessments of chronic kidney disease (CKD)-associated pruritus, based on ratings of how much they were “bothered by itchy skin.” Patterns of CKD-associated pruritus were assessed, along with associations with laboratory values and patient-reported outcomes.

Moderate to severe pruritus was reported in at least one assessment by 51% of patients and at both assessments by 22%. Prevalence of depression, restless sleep, and feeling drained increased over time in patients with incident pruritus and decreased in those with resolved pruritus compared with little or no change in those with absent or persistent pruritus. Most patients with bothersome pruritus were not taking medications traditionally prescribed for this indication.

Reported pruritus was unrelated to changes in laboratory values over time. However, persistent CKD-associated pruritus was associated with increases in adverse outcomes compared with no pruritus at either assessment: Hazard ratio was 1.29 for all-cause mortality, 1.17 for all-cause hospitalization, and 1.48 for cardiovascular events.

This large, international cohort study finds that many patients are bothered by moderate to severe CKD-associated pruritus and that pruritus symptoms often persist. Pruritus is linked to increased rates of adverse outcomes, including death, hospitalization, and cardiovascular events. The researchers discuss the need for frequent, standardized assessment of CKD-associated pruritus symptoms and studies to determine whether pruritus treatments can affect adverse outcome rates [Sukul N, et al. Pruritus in hemodialysis patients: Longitudinal associations with clinical and patient-reported outcomes. Am J Kidney Dis, published online ahead of print August 16, 2023. https://www.ajkd.org/article/S0272-6386(23)00729-1/fulltext].

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