Quality of life and clinical data in hemodialysis patients with different degrees of pruritus

Abstract

Chronic kidney disease-associated pruritus (CKD-aP), a persistent itching sensation, is prevalent among hemodialysis patients. This study aims to understand its prevalence, its possible association with selected solutes, and impact on quality of life (QoL) in hemodialysis patients. Involving 434 hemodialysis patients in Spain, this observational study employed a survey based on validated pruritus assessment tools, alongside demographic, clinical, and biochemical data collection. The study used statistical analyses to examine the correlation between CKD-aP and various QoL dimensions. CKD-aP affected 46,4% (202) of the participants, with no significant variation across gender and age (p = 0.222 and p = 0.379, respectively). There were no significant associations between CKD-aP and biochemical markers like calcium, phosphate, and C-reactive protein (p > 0.05, in all cases). Each reporting period (morning, midday, evening, and night) revealed distinct patterns in pruritus prevalence and severity (p < 0.05). The nighttime report exhibited the most significant differences, as more than half of the patients with moderate to severe pruritus reported constant and frequent itching (23.0% and 27.9%, respectively). Concerning other variables and symptoms associated with QoL, pruritus group exhibited higher rates of anxiety, depression, decreased sexual desire and sexual function, and sometimes to most of the time reported sleep onset problems, sleeping pill use, and drowsiness on waking (p < 0.001 in all cases). When stratifying by pruritus intensity differences persisted across anxiety (p < 0.001) and sleep onset problems (p = 0.018). The findings underscore the high prevalence and severe impact of CKD-aP in QoL among hemodialysis patients, indicating a need for standardized screening and treatment approaches in clinical practice. The lack of correlation with common biochemical markers suggests an intricate pathophysiology, warranting further investigation. These insights emphasize the necessity of holistic management strategies and more research to understand CKD-aP complex nature for better patient outcomes.

Keywords: Biochemical markers; CKD-aP; Chronic kidney disease; Psychosocial disorders; Sexuality.

Fig. 1

Main symptoms related with emotional sphere and sexuality (A), and sleep quality (B) in patients with pruritus vs. non-pruritus.