Chronic Kidney Disease-Associated Pruritus Burden: A Patient Survey Study

Abstract

Rationale & ObjectiveChronic kidney disease–associated pruritus (CKD-aP) is a common, underrecognized condition in patients with chronic kidney disease (CKD), especially those receiving hemodialysis (HD). The present study analyzed the clinical treatment journey and overall burden of pruritus among patients with CKD-aP. Study DesignCross-sectional, patient-reported online survey. Setting & ParticipantsData from adult patients undergoing HD (December 2021-May 2022) in the United States. ExposurePatients participated in an online survey and responded to questions on validated patient-reported outcome (PRO) instruments related to CKD-aP. OutcomesSelf-reported measures analyzed at the end of this survey include itch characteristics, symptom management, healthcare provider (HCP) engagement, and impact on HD, quality of life (QoL), sleep, and work productivity. Analytical ApproachBivariate analysis assessed the association of itch severity with CKD-specific QoL. ResultsOverall, 354 patients with CKD-aP were included in analyses, of which 49% and 30% had moderate and severe itch, respectively (22% were mild). Around 68% reported symptoms to HCPs, most commonly a nephrologist or primary care provider, and 55% received a treatment recommendation. The most common treatments were topical lotions/moisturizers (75%) and corticosteroids (48%); use of oral prescriptions was low (20%), with limited satisfaction with treatments. Overall, 23% of patients reported shortening and 17% reported missing HD sessions due to itch. In bivariate analysis, patients with more severe CKD-aP reported significantly worse disease and function scores [kidney disease (KD) score, cognitive function, quality of social interaction, sleep (all, P<0.001), and sexual function (P<0.05)], suggesting a direct impact of CKD-aP on QoL. LimitationsPossible recall bias, especially for questions with longer recall periods. ConclusionsCKD-aP is often inadequately treated, and disruptive of dialysis treatment, even among patients who report itch to HCPs. Worse itch severity is associated with poorer QoL, sleep quality, and functional/work impairment.