Pruritus and long-term hemodialysis among patients with chronic renal failure (original) (raw)
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Therapeutic Apheresis and Dialysis, 2019
CKD-associated pruritus is one of the common symptoms in patients undergoing dialysis, thus contributing to the diminished and compromised quality of life. This study aimed to explore the association between the CKD-associated pruritus on quality of life of patients undergoing hemodialysis in Malaysia. A cross-sectional multicenter study, carried out from February to September 2017 at tertiary care settings in Kuala Lumpur, Malaysia. Patients aged 18 years and above, undergoing hemodialysis, understanding Malay language and willing to participate were included. The CKD-associated pruritus was assessed by using Malay 5D-itch scale and Malay FANLTC questionaiare. To determine the factors associated with pruritus and quality of life, multivariate logistic regression analysis was used having P value < 0.05 as statistically significant. Among n = 334 recruited patients with a response rate of 100%, 59.6% were males and total of 61.3% were having CKD-associated pruritus.
Ethiopian Journal of Health Sciences, 2016
BACKGROUND: Pruritus is a common cutaneous manifestation of chronic kidney disease (CKD). It is associated with poor sleep quality, anxiety and depression which may contribute to reduction in quality of life (QoL). Paying more attention to pruritus in CKD patients may improve their QoL, reduce kidney disease burden and mortality. This study determined the prevalence, pattern and association of pruritus with QoL in CKD patients. MATERIALS AND METHODS: This was a cross-sectional descriptive study carried out in a Kidney Care Centre, Ondo City, Southwest Nigeria. The severity and intensity of pruritus and health-related QoL were assessed using validated instruments. P-value of < 0.05 was taken as significant. RESULTS: There were 91 CKD subjects with a male:female ratio of 2.1:1. Sixty-nine (75.8%) of the CKD patients were not on dialysis while the remaining twenty-two (24.2%) were on maintenance hemodialysis (MHD). Thirty-nine (42.9%) of the CKD subjects had pruritus which was mild in 25(64.1%), moderate in 8(20.5%) and severe in 6(15.4%). Pruritus was more common in MHD patients compared to predialysis CKD patients(50%vs40.6%) p = 0.47. The median pruritus intensity score was also higher in MHD patients compared to predialysis CKD patients (40vs30) p = 0.51. There was no significant association between gender, age, aetiology of CKD, stage of CKD and pruritus. There was a significant correlation between QoL score and pruritus intensity. (p = < 0.001, r = 0.56). CONCLUSION: Pruritus was common among our CKD subjects and it was not significantly associated with age, gender, stage or etiology of CKD. There was a significant association between impaired QoL and pruritus intensity.
Pars of Jahrom University of Medical Sciences, 2013
Thi study aimed to determine the status of pruritus and its relation to dialysis adequacy and laboratory factors among hemodialysis patients in Shiraz dialysis centers so that appropriate interventions could be planned for promotion of the life quality. Materials and Methods: This is a cross-sectional study on the data collected from 141 patients selected by convenient sampling. We used a questionnaire, interview, and lab test for data collection. Data were analyzed using SPSS 11.5 software and appropriate tests. A p value=0.05 was considered as the significance level. Results: The mean age of our patients was 53±16 years, (82.3% were married), and 53.2% of them were male. Of these patients, 39.7% had pruritus and most of them (48.1%) reported they had pruritus in different times of the day. A significant correlation was found between dialysis adequacy and pruritus (p=0.029), and the correlation of pruritus and high sensitive-C-reactive protein (hs-CRP) was significantly positive (p=0.009). Conclusion: Pruritus is a common problem in haemodialysis patients and is significantly associated with dialysis adequacy and hs-CRP. The level of their quality of life could be enhanced by appropriate interventions.
Quality of Life Research
Purpose To assess whether depression symptoms, poor sleep and dry skin bother explain association between pruritus and the burden of kidney disease in maintenance hemodialysis (MHD) patients. Methods Cross-sectional study of 980 patients from a prospective study in dialysis units of Salvador, Brazil (PROHEMO). The Kidney Disease Quality of Life Short Form was used to determine scores of kidney disease burden (KDB) and sleep with higher scores indicating lower perceived burden and better sleep quality, respectively. The Center for Epidemiological Studies Depression Scale was used for depression symptoms. Results Prevalence of severe pruritus (very much or extreme) was 19.4%. Significantly (P < 0.001) lower mean KDB score by 11.44 points was observed for patients with severe pruritus (34.18 ± 27.51) than for those with no pruritus (45.62 ± 30.73). Severe pruritus was associated with poorer sleep quality, higher odds of dry skin bother and higher depression symptoms score. Association of pruritus with KDB score was virtually eliminated after adjustment for sleep, dry skin bother and depression symptoms. Conclusions This study shows strong associations of severe pruritus with higher depression symptoms, poorer sleep and dry skin bother among MHD patients. The results support special attention to MHD patients with pruritus who often face high psychological burden.
Hemodialysis International, 2014
Pruritus affects many patients undergoing hemodialysis (HD). In this study, pruritus and its relationship to morbidity, quality of life (QoL), sleep quality, and patient laboratory measures were analyzed in a large sample of Japanese patients undergoing HD. Severity of patient-reported pruritus symptoms experienced during a 4-week period was collected from 6480 Japanese patients undergoing HD in three phases of the Dialysis Outcomes and Practice Patterns Study (DOPPS; 1996-2008; 60-65 study facilities/phase). Adjusted linear and logistic regressions were used to identify associations of pruritus with treatment parameters and QoL outcomes. Adjusted Cox regressions examined the influence of pruritus severity on mortality. Moderate to extreme pruritus was experienced by 44% of prevalent patients undergoing HD in the Japanese Dialysis Outcomes and Practice Patterns Study. Many patient characteristics were significantly associated with pruritus, but this did not explain the large differences in pruritus among facilities (20-70%). Pruritus was slightly less common in patients starting HD than in patients on dialysis >1 year. Patients with moderate to extreme pruritus were more likely to feel drained (adjusted odds ratio = 2.2-5.8, P < 0.0001), have poor sleep quality (adjusted odds ratio = 1.9-3.7, P < 0.0001), and have QoL mental and physical composite scores 2.3-6.7 points lower (P < 0.0001) than patients with no/mild pruritus. Pruritus in patients undergoing HD was associated with a 23% higher mortality risk (P = 0.09). The many poor outcomes associated with pruritus underscore the need for better therapeutic agents to provide relief for the 40-50% of prevalent patients undergoing HD substantially affected by pruritus. Pruritus in new patients with end-stage renal disease likely results from uremia or pre-existing conditions (not HD per se), indicating the need to understand development of pruritus before end-stage renal disease.
Nephrology Dialysis Transplantation, 2006
Background. Pruritus affects many haemodialysis (HD) patients. In this study, pruritus and its relationship to morbidity, mortality, quality of life (QoL), sleep quality and patient laboratory measures were analysed in >300 dialysis units in 12 countries. Methods. Pruritus data were collected from 18 801 HD patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Analyses were adjusted for age, gender, black race, Kt/V, haemoglobin, serum albumin, albumin-corrected serum calcium, serum phosphorus, 13 comorbidities, depression, years on dialysis, country and facility clustering effects. Results. Moderate to extreme pruritus was experienced by 42% of prevalent HD patients in DOPPS during 2002/2003. Many patient characteristics were significantly associated with pruritus, but this did not explain the large differences in pruritus between countries (ranging from 36% in France to 50% in the UK) and between facilities (5-75%). Pruritus was slightly less common in patients starting HD than in patients on dialysis >3 months. Pruritus in new end-stage renal disease (ESRD) patients likely results from pre-existing conditions and not haemodialysis per se, indicating the need to understand development of pruritus before ESRD. Patients with moderate to extreme pruritus were more likely to feel drained [adjusted odds ratio (AOR) ¼ 2.3-5.2, P < 0.0001] and to have poor sleep quality (AOR ¼ 1.9-4.1, P 0.0002), physiciandiagnosed depression (AOR ¼ 1.3-1.7, P 0.004), and QoL mental and physical composite scores 3.1-8.6 points lower (P < 0.0001) than patients with no/mild pruritus. Pruritus in HD patients was associated with a 17% higher mortality risk (P < 0.0001), which was no longer significant after adjusting for sleep quality measures. Conclusions. The pruritus/mortality relationship may be substantially attributed to poor sleep quality. The many poor outcomes associated with pruritus underscore the need for better therapeutic agents to provide relief for the 40-50% of HD patients affected by pruritus.
Journal of Community Service for Health
Patients of chronic kidney disease require long-term hemodialysis therapy. However, this therapy has various complications, one of which is pruritus. Pruritus can interfere with individual activities, cause sleep disturbances, lesions and hyperpigmentation on the skin, to impact the patient's quality of life. So that non-pharmacological management is needed to treat pruritus. The design was cross sectional. The population in this community service was chronic kidney failure patients undergoing hemodialysis therapy in the hemodialysis room. The sample was patients who experience pruritus and undergo hemodialysis therapy at least 1x / week as many as 45 people. The variables were health education related to non-pharmacological management and pruritus. The instruments used leaflets and counseling program units for health education, while for pruritus used the Numeric Rating Scale. The average patient experienced pruritus on a scale of 5, which was a moderate category where itching ...
Our Dermatology Online, 2015
Introduction: Uremic pruritus (UP) is a common and distressing complication of end-stage renal disease (ESRD). A global cross-sectional study of 18,000 hemodialysis patients reported a 42% prevalence of moderate or extreme UP, which was strongly associated with sleep disturbance, depression, impaired quality of life, and mortality. Pruritus is commonly encountered in individuals with end-stage renal disease (ESRD) on hemodialysis (HD). Materials and Methods: This cross-sectional study was performed in order to find out the prevalence of pruritus in patients on regular maintenance hemodialysis (HD) as well as to analyze its relationship to age, sex of the patient, duration of hemodialysis in months per patient, serum levels of phosphate, PTH, KT/V (index of dialysis dose), parameters in the beggining of the study and six months after. The data were analyzed by descriptive statistics-Wilcoxon Signed Rank Test and Chi-square test with Yates correction factor. Results: Sixty and two patients with ESRD (age ranging from 31 to 87 years) free from systemic, skin or psychiatric disorders and other secondary causes attributable to pruritis, undergoing maintenance HD (duration on HD 4-348 months; mean 86.97 and median 79,5 months) at Fresenius dialysis center, Banja Luka, Bosnia and Herzegovina were evaluated for pruritus. Pruritus has been discovered in 21 out of 34 males (54,8%) and 6 out of 28 females (22,2%). Our study as many others showed that pruritus is very common (45.2%) in HD patients. Applying c 2 test with Yates correction factor is highly statistically significant (c 2 = 8.003, p = 0.005) by gender. Research of the gender revealed that pruritus appeared more in men analysis. There were no significant differences between other measured markers: to age, duration of hemodialysis in months per patient, serum levels of phosphate, PTH, KT/V (index of dialysis dose) in patients with pruritus and in patients without pruritus. Conclusions: This first cross-sectional study describes key features UP in Republic of Srpska (Bosnia and Herzegovina) and results that the UP is significantly more common in men. This study demonstrates that the serum level of PTH and phosphate isn't associated with the incidence of pruritus in HD patients.
Prevalence, patient burden and physicians’ perception of pruritus in hemodialysis patients
Nephrology Dialysis Transplantation, 2023
Background. Chronic kidney disease-associated pruritus (CKD-aP) is an underrated symptom in patients with impaired kidney function. The present study assessed the prevalence, impact on quality of life (QoL) and risk factors for CKD-aP in a contemporary national cohort of patients on hemodialysis. In addition, we evaluated attending physicians' awareness and approach to therapy. Methods. Validated patient's and physician's questionnaires on pruritus severity and QoL were used in combination with information obtained by the Austrian Dialysis and Transplant Registry. Results. The prevalence of mild, moderate and severe pruritus in 962 observed patients was 34.4, 11.4, and 4.3%. Physicians' estimated prevalence values were 54.0 (42.6-65.4), 14.4 (11.3-17.6) and 6.3% (4.9-8.3), respectively. The estimated national prevalence estimate extrapolated from the observed patients was 45.0 (95% CI 39.5-51.2) for any, 13.9 (10.6-17.2) for moderate and 4.2% (2.1-6.2) for severe CKD-aP. CKD-aP severity was significantly associated with impaired QoL. Risk factors for moderate to severe pruritus were higher Creactive protein (OR 1.61; 95% CI 1.07-2.43) and parathyroid hormone values (OR 1.50; 95% CI 1.00-2.27). Therapy of CKD-aP included changes in the dialysis regime, topical treatments, antihistamines, gabapentin and pregabalin, and phototherapy in a majority of centers. Conclusions. While the overall prevalence of CKD-aP in our study is similar to previously published literature, the prevalence of moderate to severe pruritus is lower. CKD-aP was associated with reduced QoL and raised markers of inflammation and parathyroid hormone. The high awareness of CKD-aP in Austrian nephrologists may explain the lower prevalence of more severe pruritus. KEY LEARNING POINTS What was known:-While the overall prevalence of CKD-aP in our study is similar to previously published literature, the prevalence of moderate to severe pruritus is lower This study adds:-Awareness of chronic kidney disease-associated pruritus (CKD-aP) is high in Austrian nephrologists compared to previously published literature Potential impact:-High awareness and a multimodal treatment approach might explain the lower prevalence of moderate to severe pruritus in this study
Academia Journal of Medicine, 2019
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.