Pruritus is present in one-third of patients receiving maintenance dialysis and is associated with increased rates of several adverse health outcomes, reports a study in the American Journal of Kidney Diseases.
The researchers assessed the burden of pruritus in 3281 patients receiving hemodialysis or peritoneal dialysis in Stockholm, Sweden, between 2005 and 2021. Two-thirds of patients were men; the median age was 64 years. Rates of clinically recognized pruritus were assessed, based on diagnostic codes or prescription of pruritus treatments, including ultraviolet therapy. Patient factors associated with prevalent or incident pruritus were analyzed. The study also examined associations with clinical outcomes including mortality, severe infections, anxiety or depression, and sleep disorders.
Pruritus was present at baseline in 13.9% of patients and developed during follow-up (median, 3.3 years) in an additional 19.1%. Period prevalence was higher in patients receiving hemodialysis (36.0%) compared with peritoneal dialysis (26.4%). Most cases were identified through initiation of pruritus treatments rather than diagnostic codes.
A wide rate of patient and clinical factors was linked to pruritus, including older age; female sex; lower serum albumin; and higher C-reactive protein, serum calcium, and serum phosphorus. Patients with pruritus were more likely to have sleep disorders (hazard ratio [HR], 1.96) and anxiety or depression (HR, 1.56). Pruritus was also associated with a significant increase in hospitalizations for severe infections (HR, 1.36), mainly reflecting higher rates of sepsis and peritonitis in patients undergoing peritoneal dialysis. There was no association with all-cause mortality.
Although pruritus is common in patients on dialysis, the overall burden of this complication and its impact on clinical outcomes remain unclear. The new analysis finds evidence of pruritus in 33% of patients on maintenance dialysis, consistent with the range reported in previous studies.
The study identifies clinical risk factors associated with pruritus and associations with certain adverse outcomes, although not with mortality. The researchers conclude, “Individualized clinical management to prevent and to treat this burdensome uremic symptom might significantly improve patients’ quality of life and potentially health outcomes” [Faucon A-L, et al. Burden of CKD-associated pruritus and adverse clinical outcomes in patients receiving dialysis: The Stockholm CREAtinine Measurements (SCREAM) project. Am J Kidney Dis, published online July 25, 2024. doi: 10.1053/j.ajkd.2024.05.013].
