Prevalence and Association of Pruritus and its Current Treatment during the First Year of Dialysis: A Dutch Nocturnal and Home Dialysis Study to Improve Clinical Outcomes Study.

KEY POINTS: Incident dialysis patients show a high prevalence of pruritus during the first year of dialysis, with pruritus being either persistent or fluctuating. Medical treatment for pruritus does not improve quality of life within the 25% of patients with pruritus receiving it. High prevalence, negative effect, and low treatment rate of pruritus urges for more awareness, for instance, by the means of patient reported outcomes.

BACKGROUND

Pruritus is common in dialysis patients and associated with impaired health-related quality of life (HRQoL) and sleep disturbances. Its pathophysiology remains unclear, resulting in limited treatment options and lack of treatment guidelines. The exact trajectory of pruritus after dialysis initiation, nor the state of current medical treatment, has been studied.

METHODS

Incident dialysis patients (N=1438) included in the Dutch nocturnal and home dialysis study to improve clinical outcomes were studied. Outcome parameters were prevalence of pruritus, severity of pruritus, and the use of antipruritic medication, repeatedly measured during the first year of dialysis. Associations between treatment, pruritus, and quality of life were longitudinally studied using linear mixed models.

RESULTS

The prevalence of pruritus ranged from 50.5% to 56.6% during the first year of dialysis. Throughout the year, approximately 35% experienced persistent pruritus and 40% fluctuating pruritus. During follow-up, 21.5%–26.5% received medical treatment for pruritus. Emollients were associated with more severe pruritus (adjusted β=0.31; 95% confidence interval [CI], 0.15 to 0.48); the remaining treatments did not show any association. Pruritus was significantly associated with lower physical and mental HRQoL (adjusted β=−2.04; 95% CI, −2.78 to −1.30 and β=−1.73; 95% CI, −2.51 to −0.94, respectively), irrespective of treatment.

CONCLUSIONS

During the first year of dialysis, pruritus is highly prevalent, predominantly fluctuating, and associated with impaired HRQoL. The minority of patients received medical treatment; in our study, current treatment was not associated with an improvement of pruritus. These results highlight the need for more awareness among clinicians and for the development of effective treatment options.