Prevalence and Outcomes of Chronic Kidney Disease-Associated Pruritus

Key Points CKD-associated pruritus is highly prevalent among peritoneal dialysis patients. Pruritus is associated with reduced health-related quality of life, and the composite of mortality and transfer to hemodialysis for peritoneal dialysis patients. Efforts to better identify and manage pruritus in this population are needed. Background Pruritus is common in hemodialysis patients. Less is known about the prevalence and outcomes of pruritus among patients receiving peritoneal dialysis (PD). Herein, we describe the prevalence of pruritus and its associations with patient-reported outcomes (PROs) and mortality/transfer to hemodialysis. Methods We analyzed a multicenter, international cohort of PD patients enrolled in the PD Outcomes and Practice Patterns Study from 2014 to 2022. Pruritus was assessed at entry into the PD Outcomes and Practice Patterns Study with a single-question Likert Scale capturing the extent to which patients were bothered by itch ranging from 1: not at all to 5: extremely . The kidney disease quality of life-36 and the Center for Epidemiological Studies Depression Scale assessed various PROs. Moderate-to-extreme pruritus was defined as a Likert scale score ≥3. The associations of pruritus with PROs were assessed using linear/logistic regression where appropriate. Death or hemodialysis transfer was assessed using multivariable Cox regression models. Results Overall, 5535 patients from eight countries were included; 43% had moderate-to-extreme pruritus which was the highest in Thailand (50%) and the lowest in the United States (33%). The adjusted odds ratios of moderate-to-extreme pruritus were higher for diabetes, low albumin, and elevated phosphorus but lower for residual urine volume (adjusted odds ratio, 0.98 per 200 ml increase in 24-hour urine volume; 95% confidence interval, 0.96 to 1.00; P = 0.05). Patients with extreme pruritus had the lowest mental and physical health component scores and a higher burden of other PROs including restless legs and disturbed sleep. Overall, 921 patients died and 1150 were transferred to hemodialysis. Patients with moderate-to-extreme pruritus were at higher adjusted risk for death or hemodialysis transfer (adjusted hazard ratio, 1.12; 95% confidence interval, 1.02 to 1.23; P = 0.02) with similar point estimates for each subcomponent of the composite outcome. Conclusions Pruritus is highly prevalent in PD and associated with poor health outcomes. Efforts to better identify and manage pruritus should be considered in this population.