Chronic Kidney Disease-Associated Pruritus in Danish Dialysis Patients: A Cross-Sectional Multicenter Study of Prevalence, Disease Burden, and Current Treatment Practices.

RATIONALE &

OBJECTIVE

Chronic kidney disease-associated pruritus (CKD-aP) is rarely systematically assessed despite the potential negative impact on quality of life (QoL). This study investigated prevalence, disease burden, physician awareness, and treatment practices.

STUDY

DESIGN

Multicenter cross-sectional study using patient-reported outcome measures and a physician practice survey.

SETTING & POPULATION: Adult patients with chronic kidney failure requiring replacement therapy and nephrologists from 8 Danish hospitals.

EXPOSURE: Kidney failure requiring replacement therapy and dialysis modality.

OUTCOMES: CKD-aP prevalence (score, >4) and pruritus severity (range, 0-10) according to the Worst Itch Numeric Rating Scale (WI-NRS). QoL and skin distribution assessed with the 5-D itch scale (range, 5-25). Physician awareness and treatment practices (self-invented questionnaire).

ANALYTICAL APPROACH: Descriptive statistics were used.

RESULTS

We recruited 642 patients (∼25% of the Danish dialysis population): 83% receiving hemodialysis (HD), 13% receiving peritoneal dialysis, and 4% receiving home HD (HHD). The median WI-NRS score (IQR) was 0 (0-4). CKD-aP prevalence (95% CI) was 21% (18%-24%) (WI-NRS, >4). Moderate to very severe pruritus (WI-NRS, ≥4) was found in 25% (19%-32%). The median 5-D score (IQR) was 5 (5-10) (all patients). Peritoneal dialysis patients had significantly higher WI-NRS and 5-D scores than HD and HHD patients. Overall, the impact of CKD-aP on daily activities was minimal, but sleep disability (score, >1) was found in 20%. Sleep disability correlated significantly with higher WI-NRS scores. Based on 75 questionnaires (nephrologists/residents: 46/25), most physicians overestimated CKD-aP prevalence and favored dialysis, and fatty cream and phosphate-lowering treatment, rather than systemic treatment with gabapentinoids or difelikefalin.

LIMITATIONS: Single time-point estimate of CKD-aP and few HHD patients. No dermatologic evaluation was performed to exclude other pruritic conditions.

CONCLUSIONS

About 1 of 5 to 1 of 4 dialysis patients had CKD-aP, which mainly impaired QoL via sleep disturbance. Physicians demonstrated adequate awareness, but treatment remained largely limited to dialysis and fatty cream. Simple patient-reported outcome measures facilitated systematic assessment.