Chronic Kidney Disease-Associated Pruritus in Haemodialysis: A Mixed-Methods Study of Symptom Burden and Patient Experience.

BACKGROUND

Chronic kidney disease-associated pruritus is a common and often under-recognized symptom among people receiving haemodialysis and may substantially impair daily life and wellbeing.

OBJECTIVES

To determine the prevalence and severity of pruritus in people receiving haemodialysis and to explore the lived experiences of those with moderate-to-severe pruritus.

DESIGN

Explanatory sequential mixed-methods study.

PARTICIPANTS

A total of 294 adults receiving haemodialysis in three dialysis centres participated in the quantitative phase. The qualitative phase included 48 participants selected from the quantitative sample who had moderate-to-severe pruritus, defined as a Five-D Itch Scale score of 12 or higher.

MEASUREMENTS: Data were collected between October 2025 and January 2026. Quantitative data were collected using the Five-Dimensional Itch Scale and a sociodemographic and clinical information form developed for this study. Qualitative data were generated through at least two semi-structured interviews with each participant and analysed using reflexive thematic analysis. Integration was performed at the interpretation stage.

RESULTS

The mean Five-Dimensional Itch Scale score was 8.00 ± 3.21, and moderate-to-severe pruritus prevalence was 16.3%. Multivariable analysis showed lower symptom reporting among married participants, whereas comorbidity and previous pruritus-related education were associated with higher symptom reporting. Qualitative findings indicated that pruritus was experienced as a fluctuating burden affecting sleep, daily comfort, and social roles. Participants described trial-and-error self-management strategies and expressed a need for proactive assessment, practical guidance and individualised nursing care.

CONCLUSIONS

Chronic kidney disease-associated pruritus remains a multidimensional burden in haemodialysis care. Standardised assessment and person-centred nursing care may improve its recognition and management.