International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

医学 瘙痒的 血液透析 生活质量(医疗保健) 透析 内科学 皮肤病科 护理部
作者
Hugh Rayner,Maria Larkina,Mia Wang,Matthew Graham‐Brown,Sabine N van der Veer,Tevfik Ecder,Takeshi Hasegawa,Werner Kleophas,Brian Bieber,Francesca Tentori,Bruce Robinson,Ronald L. Pisoni
出处
期刊:Clinical Journal of The American Society of Nephrology [American Society of Nephrology]
卷期号:12 (12): 2000-2007 被引量:197
标识
DOI:10.2215/cjn.03280317
摘要

Background and objectives Uremic pruritus in patients on hemodialysis is associated with depression, lower quality of life, and mortality. We studied the prevalence, awareness, and treatment of pruritus to assess how well this important condition is currently managed internationally. Design, setting, participants, & measurements Data from 35,452 patients on hemodialysis in up to 17 countries from the Dialysis Outcomes and Practice Patterns Study were analyzed to describe pruritus prevalence from 1996 to 2015. Data from 6256 patients and 268 medical directors in 17 countries in 2012–2015 were analyzed to describe predictors, effects, medical directors’ awareness, and treatment of pruritus. Results Patients very much or extremely bothered by itching declined from 28% in 1996 to 18% in 2015. In 2012–2015, among patients nearly always or always bothered by itching, pruritus had a major effect on work and social life; 18% used no treatment for pruritus, and 17% did not report itching to health care staff. In total, 69% of medical directors underestimated the prevalence of pruritus in their unit. Managing high serum phosphorus and low Kt/V was ranked as the most important intervention, but no relationship was found between these factors and pruritus; 57% of medical directors used oral antihistamines for first-line chronic treatment of pruritus. Gabapentin was used by 45% as first-, second-, or third-line treatment. Nalfurafine was only used in Japan. Conclusions The prevalence of pruritus in people on hemodialysis is decreasing but remains underestimated. Large numbers of patients on hemodialysis with severe pruritus do not receive treatment. There is wide variation in the use of unlicensed medications for the treatment of pruritus. These data provide a benchmark for initiatives to improve the management of uremic pruritus. Multimedia This article contains multimedia at https://vimeo.com/49458473 This article contains multimedia at vimeo.com/49455976

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