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. 2025 Jun 15;17(6):e86058.
doi: 10.7759/cureus.86058. eCollection 2025 Jun.

Metabolomic Analysis of Uremic Pruritus in Patients on Hemodialysis

Jehangir Afzal Mobushar  1   2 , Syeda Mayedah Hussain  3 , Waqas Amjad  3 , Ugal Kishore  4   5 , Adnan Ahmad Zafar  6 , Muhammad Noman Qureshi  7   8 , Muhammad Irfan Jamil  9 , Iqra Naeem  10 , Adeel Ahmed  11
Affiliations

Metabolomic Analysis of Uremic Pruritus in Patients on Hemodialysis

Jehangir Afzal Mobushar et al. Cureus. .

Abstract

Background: Uremic pruritus (UP) is a prevalent and distressing complication among patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis (HD). Despite its significant impact on quality of life and mortality, the underlying pathophysiology remains incompletely understood, with evidence implicating metabolic and inflammatory factors.

Objective: This study aimed to determine the prevalence of UP and assess its association with selected metabolic and inflammatory biomarkers in patients undergoing maintenance HD.

Methods: A cross-sectional observational study was conducted at the Dialysis Centre of Lahore General Hospital, a tertiary care hospital in Lahore, Pakistan. A total of 281 adult HD patients were enrolled. Pruritus was assessed using the 5-D Itch Scale, with a score ≥10 defining cases. Demographic and clinical data were recorded, and laboratory parameters including hemoglobin, calcium, phosphate, magnesium, intact parathyroid hormone (iPTH), uric acid, lipid profile, high-sensitivity C-reactive protein (hs-CRP), and white blood cell (WBC) count were analyzed. Associations were assessed using chi-square and independent samples t-tests. Multivariate logistic regression identified independent predictors of pruritus.

Results: The prevalence of UP was 82 (29.2%). Significant differences were observed between pruritic and non-pruritic groups in age, dialysis duration, and several biochemical parameters. Independent predictors of pruritus included advancing age (OR = 1.148, p < 0.001), serum phosphate (OR = 2.069, p < 0.001), uric acid (OR = 1.680, p < 0.001), iPTH (OR = 1.007, p < 0.001), hs-CRP (OR = 1.596, p = 0.001), magnesium (OR = 9.687, p = 0.020), triglycerides (OR = 1.018, p = 0.025), and HCV infection (OR = 8.098, p = 0.001). No significant associations were found with gender, diabetes, dialysis frequency, or vascular access.

Conclusion: UP in HD patients is significantly associated with metabolic and inflammatory derangements rather than demographic or dialysis-related variables. These findings underscore the importance of targeted metabolic control and inflammation modulation in managing pruritus among dialysis populations.

Keywords: 5-d itch scale; end-stage renal disease (esrd); maintenance hemodialysis; metabolic profile; uremic pruritus.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Postgraduate Medical Institute/Amer-Ud-Din Medical College/Lahore General Hospital, Lahore issued approval 0133/06/2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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