Prevalence of Uremic Pruritus, Its Risk Factors and Impact on Health Related Quality-Of-Life in Patients on Maintenance Hemodialysis
DOI:
https://doi.org/10.48165/65z8ry65Keywords:
Uremia, uremic/renal pruritus, maintenance hemodialysis, health-related quality of life, sleepAbstract
Background: Renal pruritus is one of the most debilitating symptom of chronic kidney disease especially affecting patients on maintenance hemodialysis. Subjects and Methods: It was a cross-sectional questionnaire based study. Demographic, dialysis related and biochemical parameters of maintenance hemodialysis patients were recorded, and a pre-defined questionnaire was put to them. Severity was calculated with 12 point pruritus severity scale (PSS), health-related quality of life with SKINDEX-10, and sleep survey with ITCH-MOS. Results: The total of 164 patients (mean age 52 ± 17years, males-57.9%, females-42.1%) completing questionnaire and laboratory analysis were included in the study. Prevalence of pruritus was 53.7% (mild in 31.8%, moderate-45.5%, severe-22.7%). Prevalence was higher in diabetic CKD (p=0.0001), and irregularly dialyzed patients (p=0001). The severity of pruritus correlated with older age (p=0.004), shorter dialysis vintage (p=0.000), irregular dialysis (0.000), higher serum phosphorus (0.003), and parathyroid hormone level (0.000) and higher calcium-phosphorus product (0.001). SKINDEX-10 showed worsening symptoms, emotional and functional quality of life (p=0.000), and poorer sleep quality and quantity as per ITCH-MOS (0.000), with increasing severity of itching. Conclusion: Renal itch is highly prevalent in maintenance hemodialysis patients, most severely affecting diabetics, elderly, irregularly dialyzed patients, with poorly controlled mineral bone parameters. The severity correlates with worsening sleep and overall quality-of-life.
References
1. Balaskas, EV, Chu M, Uldall RP, Gupta A, Oreopoulos DG. Pruritus in continuous ambulatory peritoneal dialysis and hemodialysis patients. Perit Dial Int. 1993; 13: S527–S532.
2. Berger TG, Steinhoff M. Pruritus and renal failure. Semin Cutan Med Surg. 2011; 30 (2): 99–100. doi:10.1016/j.sder.2011.04.005 3. Patel TS, Freedman BI, Yosipovitch G. An update on pruritus associated with CKD. Am J Kidney Dis. 2007; 50: 11–20.
4. Mettang M, Weisshaar E. Pruritus: Control of itch in patients undergoing dialysis. Skin Ther Lett. 2010; 15: 1–5.
5. Reich A, Bożek A, Janiszewska K, Szepietowski JC. 12-Item Pruritus Severity Scale: Development and Validation of New Itch Severity Questionnaire. BioMed Research International. 2017; Article ID 3896423: 7 pages. https://doi.org/10.1155/2017/3896423.
6. Mathur VS, Lindberg J, Germain M, Block G, Tumlin J, Smith M et al. A longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol. 2010; 5: 1410–9.
7. Narita I, Iguchi S, Omori K, Gejyo F. Uremic pruritus in chronic hemodialysis patients. J. Nephrol. 2008;21: 161–5.
8. Kim KH, Lee MS, Choi SM, Ernst E. Acupuncture for treating uremic pruritus in patients with end-stage renal disease: a systematic review. J. Pain Symptom Manag. 2010; 40: 117–25. doi: 10.1016/j.jpainsymman.2009.11.325.
9. Khan TM, Wu DBC, Goh BH, Lee LH, Alhafez AA, Sulaiman SAS. An Observational Longitudinal Study Investigating the Effectiveness of 75 mg Pregabalin Post-Hemodialysis among Uremic Pruritus Patients. Sci. Rep. 2016; 6: 36555. doi: 10.1038/srep36555.
10. Feramisco JD, Berger TG, Steinhoff M. Innovative management of pruritus. Dermatol Clin. 2010; 28: 467–78.
11. Sanai M, Aman S, Nadeem M, Kazmi AH. Dermatologic manifestations in patients of renal disease on hemodialysis. J. Pak. Assoc. Dermatol. 2016; 20: 163–8.
12. Rehman IU, Chohan TA, Bukhsh A, Khan TM. Impact of Pruritus on Sleep Quality of Hemodialysis Patients: A Systematic Review and Meta-Analysis. 2019. Medicina (Kaunas); 55(10): 699. doi: 10.3390/medicina55100699.
13. Pisoni RL, Wikstrom B, Elder SJ, Akizawa T, Asano Y, Keen ML, et al. Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS) Nephrol Dial Transplant. 2006; 21: 3495–505.
14. Duque MI, Thevarajah S, Chan YH, Tuttle AB, Freedman BI, Yosipovitch G. Uremic pruritus is associated with higher kt/V and serum calcium concentration. Clin Nephrol. 2006; 66: 184–91.
15. Narita I, Alchi B, Omori K, Sato F, Ajiro J, Sagaet D et al. Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney Int. 2006; 69: 1626–32.
16. Ko MJ, Wu HY, Chen HY, Chiu YL, Hsu SP, Pai MF, et al. Uremic pruritus, dialysis adequacy, and metabolic profiles in hemodialysis patients: a prospective 5-year cohort study. PLoS One. 2013;8:e71404.
17. Chiu YL, Chen HY, Chuang YF, Hsu SP, Lai CF, Pai MF, et al. Association of uraemic pruritus with inflammation and hepatitis infection in haemodialysis patients. Nephrol Dial Transplant. 2008; 23: 3685–9.
18. Yamamoto Y, Hayashino Y, Yamazaki S, Akiba T. Depressive symptoms predict the future risk of severe pruritus in haemodialysis patients: Japan Dialysis Outcomes and Practice Patterns Study. Br J Dermatol. 2009;161: 384–9.
19. Combs SA, Teixeira JP, Germain MJ. Pruritus in Kidney Disease. Semin Nephrol. 2015; 35(4): 383–91. doi:10.1016/j.semnephrol.2015.06.009.
20. Lopes GB, Nogueira FC, de Souza MR, Penalva MA, de Amorim JL, Pisoni RL, et al. Assessment of the psychological burden associated with pruritus in hemodialysis patients using the kidney disease quality of life short form. Qual Life Res. 2012;21: 603–12.
21. Kosmadakis G, Papakonstantinou S, Theodoros C, Emmanouel P, Demetrios V, Nicolas Z. Characteristics of uremic pruritus in hemodialysis patients: data from a single center. Kidney Int. 2008; 74: 962-3.
22. Tessari G, Dalle Vedove C, Loschiavo C, Tessitore N, Rugiu C, Lupo A, et al. The impact of pruritus on the quality of life of patients undergoing dialysis: a single centre cohort study. J Nephrol. 2009; 22: 241–8.
