Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan 1;6(1):95-104.
doi: 10.34067/KID.0000000615. Epub 2024 Oct 16.

Prevalence and Association of Pruritus and its Current Treatment during the First Year of Dialysis: A Dutch Nocturnal and Home Dialysis Study to Improve Clinical Outcomes Study

Thomas S van Lieshout  1   2   3 , Esmee Driehuis  1   4 , Alferso C Abrahams  4 , Violette de Ruijter  1 , Sanne J de Lange  4 , Anna A Bonenkamp  1   5 , An S De Vriese  6   7 , Robin W M Vernooij  4   8 , Patrick M J H Kemperman  9   10 , Thomas Rustemeyer  9 , Frans J van Ittersum  1   3 , Erik L Penne  2 , Brigit C van Jaarsveld  1   3   11 ; DOMESTICO study group
Collaborators, Affiliations

Prevalence and Association of Pruritus and its Current Treatment during the First Year of Dialysis: A Dutch Nocturnal and Home Dialysis Study to Improve Clinical Outcomes Study

Thomas S van Lieshout et al. Kidney360. .

Abstract

Key Points:

  1. Incident dialysis patients show a high prevalence of pruritus during the first year of dialysis, with pruritus being either persistent or fluctuating.

  2. Medical treatment for pruritus does not improve quality of life within the 25% of patients with pruritus receiving it.

  3. High prevalence, negative effect, and low treatment rate of pruritus urges for more awareness, for instance, by the means of patient reported outcomes.

Background: Pruritus is common in dialysis patients and associated with impaired health-related quality of life (HRQoL) and sleep disturbances. Its pathophysiology remains unclear, resulting in limited treatment options and lack of treatment guidelines. The exact trajectory of pruritus after dialysis initiation, nor the state of current medical treatment, has been studied.

Methods: Incident dialysis patients (N=1438) included in the Dutch nocturnal and home dialysis study to improve clinical outcomes were studied. Outcome parameters were prevalence of pruritus, severity of pruritus, and the use of antipruritic medication, repeatedly measured during the first year of dialysis. Associations between treatment, pruritus, and quality of life were longitudinally studied using linear mixed models.

Results: The prevalence of pruritus ranged from 50.5% to 56.6% during the first year of dialysis. Throughout the year, approximately 35% experienced persistent pruritus and 40% fluctuating pruritus. During follow-up, 21.5%–26.5% received medical treatment for pruritus. Emollients were associated with more severe pruritus (adjusted β=0.31; 95% confidence interval [CI], 0.15 to 0.48); the remaining treatments did not show any association. Pruritus was significantly associated with lower physical and mental HRQoL (adjusted β=−2.04; 95% CI, −2.78 to −1.30 and β=−1.73; 95% CI, −2.51 to −0.94, respectively), irrespective of treatment.

Conclusions: During the first year of dialysis, pruritus is highly prevalent, predominantly fluctuating, and associated with impaired HRQoL. The minority of patients received medical treatment; in our study, current treatment was not associated with an improvement of pruritus. These results highlight the need for more awareness among clinicians and for the development of effective treatment options.

PubMed Disclaimer

Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/KN9/A732.

Figures

None
Graphical abstract
Figure 1
Figure 1
Prevalence and trajectory of pruritus in incident dialysis patients. The figure above shows the trajectory of pruritus. The prevalence is reported as a proportion with 95% CI. Arrows show the proportion of patients changing among groups. The percentages for changes apply only to patients with two consecutive measurements. Patients with missing data for either of the measurements are not included in these percentages. CI, confidence interval.
Figure 2
Figure 2
Severity of pruritus over time in incident dialysis patients. The graph above shows the severity of pruritus on a five-point Likert scale (ranging from none to severe) over time.
See this image and copyright information in PMC

References

    1. Chargin L, Keil H. Skin diseases in nonsurgical renal disease. Arch Derm Syphilol. 1932;26(2):314–335. doi:10.1001/archderm.1932.01450030311010 - DOI
    1. Mueller SM, Gantenbein L, Navarini A, Stander S, Jacob A, Popko L. The first mention of itch in history? When Egyptologists scratch their heads. J Eur Acad Dermatol Venereol. 2020;34(8):1642–1643. doi:10.1111/jdv.16133 - DOI - PubMed
    1. Patel TS, Freedman BI, Yosipovitch G. An update on pruritus associated with CKD. Am J Kidney Dis. 2007;50(1):11–20. doi:10.1053/j.ajkd.2007.03.010 - DOI - PubMed
    1. Rayner HC Larkina M Wang M, et al. . International comparisons of prevalence, awareness, and treatment of pruritus in people on hemodialysis. Clin J Am Soc Nephrol. 2017;12(12):2000–2007. doi:10.2215/CJN.03280317 - DOI - PMC - PubMed
    1. Sukul N Karaboyas A Csomor PA, et al. . Self-reported pruritus and clinical, dialysis-related, and patient-reported outcomes in hemodialysis patients. Kidney Med. 2021;3(1):42–53.e1. doi:10.1016/j.xkme.2020.08.011 - DOI - PMC - PubMed

LinkOut - more resources