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. 2023 Feb 20;16(7):1102-1112.
doi: 10.1093/ckj/sfad032. eCollection 2023 Jul.

Moderate-to-severe pruritus in untreated or non-responsive hemodialysis patients: results of the French prospective multicenter observational study Pruripreva

Antoine Lanot  1   2   3 , Stanislas Bataille  4   5 , Guy Rostoker  6   7 , Pierre Bataille  8 , Philippe Chauveau  9 , Maxime Touzot  10 , Laurent Misery  11   12
Affiliations

Moderate-to-severe pruritus in untreated or non-responsive hemodialysis patients: results of the French prospective multicenter observational study Pruripreva

Antoine Lanot et al. Clin Kidney J. .

Abstract

Background: Chronic kidney disease-associated pruritus (CKD-aP) is a common condition in patients treated with hemodialysis, and has a negative impact on quality of life (QoL). Due to the lack of standardized diagnostic tools and frequent underreporting, pruritus prevalence remains poorly documented.

Methods: Pruripreva was a prospective multicenter observational study that aimed to evaluate the prevalence of moderate to severe pruritus in a cohort of French hemodialysis patients. The primary endpoint was the rate of patients with mean Worst Itch Numerical Rating Scale (WI-NRS) score ≥4 calculated over 7 days (moderate pruritus, 4-6; severe, 7-8; very severe, 9-10). Impact of CKD-aP on QoL was analyzed according to its severity (WI-NRS), using 5-D Itch scale, EQ-5D and Short Form (SF)-12.

Results: Mean WI-NRS was ≥4 in 306 patients (mean age, 66.6 years; male, 57.6%) out of 1304 and prevalence of moderate to very severe pruritus was 23.5% (95% confidence interval 21.2-25.9). Pruritus was unknown prior to the systematic screening in 37.6% of patients, and 56.4% of those affected were treated for this condition. The more severe the pruritus, the poorer the QoL according to the 5-D Itch scale, EQ-5D and SF-12.

Conclusion: Moderate to very severe pruritus was reported in 23.5% of hemodialysis patients. CKD-aP was underrated although it is associated with a negative impact on QoL. These data confirm that pruritus in this setting is an underdiagnosed and underreported condition. There is an urgent demand for new therapies to treat chronic pruritus associated with CKD in hemodialysis patients.

Keywords: chronic kidney disease; end-stage renal disease; hemodialysis; pruritus; quality of life.

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Conflict of interest statement

A.L. is on an advisory board for CSL Vifor and has received speaker honoraria and/or travel sponsorship from AstraZeneca and Bayer Health and CSL Vifor. G.R. reports consultancy fees from Astellas (board on roxadustat, 2019–2021), GlaxoSmithKline (board on daprodustat, 2022) and Vifor (board on difelikefalin, 2021–2022); reports research funding for scientific presentations from Amgen, Astellas, Baxter, Hemotech, Gambro Hospal, Nipro, Physidia and Theradial; reports honoraria from Amgen, Astellas, GlaxoSmithKline, Roche, Sanofi and Vifor; and is on the speakers’ bureau for Astellas and Baxter. P.B. reports consultancy fees from Astellas (board on roxadustat, 2019–21), GlaxoSmithKline (board on daprodustat) 2022, Vifor (board on avacopan and difelikefaline, 2021–22), AstraZeneca (speaker honoraria for dapagliflozin) and Gilead (speaker honoraria), and travel sponsorship from Sanofi. P.C. is a member of advisory board for CSL Vifor and has received speaker honoraria and/or travel sponsorship from Fresenius Kabi and Theradial. M.T. reports conflicts of interest with Vifor Pharma and Astellas. L.M. reports conflicts of interest with Vifor Pharma and Trevi. S.B. reports no conflict of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Flow chart.
Figure 2:
Figure 2:
Prevalence of pruritus.
Figure 3:
Figure 3:
Mean values of dimensions of 5-D Itch scale in patients with pruritus moderate to very severe (N = 306) during the last 2 weeks.
Figure 4:
Figure 4:
Localizations of pruritus according to 5-D Itch scale in patients with WI-NRS ≥4. Diameter of each circle is proportional to the frequency of pruritus in that localization. Localizations on the limbs are symmetrical.
Figure 5:
Figure 5:
Quality of life according to pruritus intensity. Mean (95% CI) (A) EQ-5D index score and (B) EQ-5D VAS according to pruritus severity, and (C) SF-12 PCS and (D) SF-12 MCS.
See this image and copyright information in PMC

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