A Longitudinal Study of Uremic Pruritus in Hemodialysis Patients (original) (raw)
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Advances in Dermatology and Allergology
Introduction: Uraemic pruritus is a common and burdensome symptom in patients undergoing haemodialysis. Though a significant negative impact of chronic itch on patient's quality of life is proved, this problem is still often underestimated in clinical practice. Various instruments describing itch are in use, however only recently a specific instrument for uraemic itch-Uraemic Pruritus in Dialysis Patient (UP-Dial)-questionnaire has been created. Aim: To translate and to validate the Polish version of the UP-Dial questionnaire. Material and methods: Forward and backward translations were conducted according to international standards. The validation was performed on a group of 30 patients undergoing haemodialysis and suffering from uraemic itch. Respondents completed the questionnaire twice with a 3-7 days' interval. Moreover, for convergent validity, the subjects were asked to assess their itch with the Numerical Rating Scale (NRS), 4-Item Itch Questionnaire (4IIQ) as well as ItchyQoL questionnaire. Results: The Polish version of the UP-Dial questionnaire showed very good internal consistency-Cronbach α coefficient was 0.90 for total score. The reproducibility assessed with the intraclass correlation coefficient (ICC) was also very good-0.9. Furthermore, UP-Dial correlated strongly with NRS (r = 0.74, p < 0.01), 4IIQ (r = 0.82, p < 0.01) and ItchyQoL (r = 0.88, p < 0.01). Conclusions: The Polish version of the UP-Dial questionnaire showed high internal reliability, validity and reproducibility and can be widely used both in research and in daily clinical practice.
Transformation of 5-D itch scale and numerical rating scale in chronic hemodialysis patients
BMC nephrology, 2017
Pruritus is a common and frustrating symptom in hemodialysis (HD) patients and 5-D itch scale is proposed as a reliable measurement of pruritus. However, information regarding 5-D itch scale categories is currently unavailable. We explored optimal cut-offs 5-D itching scale based on numerical rating scale (NRS) categories in HD patients. Four hundred and nine HD patients in China Medical University Hospital in December 2014 were included and severity of pruritus was estimated using NRS and 5-D itch scale. The association of NRS and 5-D itch scale was analyzed by linear regression. The optimal cut-offs for 5-D itch scale based on NRS categories were generated. The average NRS was 3.4 ± 3.0 and the average 5-D itch scale was 10.9 ± 4.8. The 5-D score was strongly correlated with the NRS: r = 0.831 (p < 0.001). NRS = -2.31 + 0.52 × (5-D scale). The averages of 5-D scales were 6.4 ± 1.5, 9.6 ± 2.2, 13.1 ± 3.2, 15.7 ± 4.4, 19.5 ± 4.4 for no, mild, moderate, severe, and very severe pru...
Clinical Kidney Journal, 2021
Chronic kidney disease-associated pruritus (CKD-aP) is a potentially distressing condition that affects a significant proportion of patients with end-stage kidney disease undergoing dialysis. CKD-aP may lead to worsening of patients’ physical and mental health-related quality of life (HRQoL) and has also been linked with worse clinical outcomes, including increased mortality. Despite these detrimental effects, evidence from real-world studies shows that CKD-aP still remains overlooked by nephrologists and underreported by patients in clinical practice. Itch is subjective and therefore its diagnosis is often dependent on patients reporting this symptom. There is an opportunity to reduce the burden of CKD-aP on dialysis patients by increasing awareness about this condition and the availability of effective treatments. It is particularly important that nephrologists and other healthcare providers routinely ask their patients if they are experiencing itch. The differential diagnosis of ...
2009
Lichen Simplex Chronicus (LSC) is a skin disorder affecting patient's psychosocial and functional status. Pruritus is a diagnostic hallmark for LSC. It is the reason for sleep disturbances, anxiety and depression. Therefore, a clinical investigation of pruritus alongside with a study of their self-reported health status is a necessary precondition for successful therapeutic results. The aim of the study is to assess the impact of pruritus on quality of life (QoL) of LSC patients'. MATERIALS AND METHODS: The presented study includes 190 outpatients diagnosed with LSC. Demographic data and disease-related characteristics were collected. Measurement tools, for assessing pruritus severity and sleep disturbance were visual analogue scale (VAS), and verbal rating scale (VRS).For the evaluation of QoL Dermatological Life Quality Index (DLQI) questionnaire was applied. RESULTS AND DISCUSSION: Main complains of patients were pruritus and sleep disturbance. 40% reported having low intensity pruritus (mean VAS 1.90), 36.84% moderate pruritus (mean VAS 5.12), and 23.15% severe pruritus (mean VAS 8.57). Results from sleep disturbance were: 4.73% reported currently having no sleep disturbance (mean VAS 0.18), 43.15 % reported having mild sleep disturbance; 47.36% have moderate sleep disturbance (mean VAS 5.46), and 4.73% severe sleep disturbance (mean VAS 8.93). The total DLQI score reported by the LSC-patients is 8.58±3.348. Patients scores were significantly high for Q1 (symptoms), Q9 (sexual difficulties) and Q10 (treatment) (p<0=001). CONCLUSION: All the reported and analyzed results indicate that pruritus is a major symptom in LSC and has a negative impact on all the QoL-domains for every patient (p<0.001). Consequently, pruritus moderately affects the QoL of the patients. This is the first study in our country, which aims to measure the impact of pruritus on QoL of LSH patients'.
British Journal of Dermatology, 2017
What's already known about this topic? Uremic pruritus (UP) is one of the most common and disturbing symptoms associated with progressive kidney disease, particularly in dialysis patients. What does this study add? This study has been established a comprehensive, multidimensional scale to assess UP in dialysis patients. The final 14-item Uremic Pruritus in Dialysis Patients (UP-Dial) scale is a practical instrument and provides satisfactory rigorous psychometric properties for validity and reliability. The UP-Dial scale may serve as a patient-reported outcome in clinical practice and can be used to standardise the effects of intervention in comparative-effectiveness research.
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.
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.
Frontiers in medicine, 2017
Several tools have been developed to assess the severity of pruritus. In Malaysia, no tool has been validated to assess pruritus in patients with chronic kidney disease (CKD). Therefore, the aim of our study was to validate the Malay 5D itching scale (M5D-IS) among patients with CKD in Malaysia. The English version of the 5D-IS was translated into Malay according to International Guidelines. Face and content validity was determined by an expert panel and pilot tested in patients with end-stage renal disease (ESRD). The M5D-IS was then validated in a tertiary hospital in Malaysia from May to June 2016. We recruited patients with (i.e., patients with ESRD) and without pruritus (i.e., patients with stage 1-3 CKD) (to determine if the M5D-IS could discriminate between the two groups), and administered the M5D-IS at baseline and 2 weeks later. Exploratory factor analysis was used to examine the construct validity. Internal consistency was assessed using Cronbach's alpha and intraclas...