Patient-Reported Outcome Measures in CKD-Associated Pruritus: A Systematic Review

Abstract

Chronic kidney disease-associated pruritus (CKD-aP) is a common and burdensome dermatologic condition in which patients can experience various symptoms. This study aimed to summarize and describe the patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) used in CKD-aP studies over the past 5 years. A total of 99 studies were identified, which included 5 different PROs and 40 different PROMs. The most frequently evaluated PRO was pruritus (n = 99), followed by health-related quality of life (HRQoL) (n = 31), sleep disturbances (n = 12), psychiatric symptoms (n = 7), and other skin symptoms (n = 5). Among the 40 different PROMs, 19 were generic, 18 were skin-specific, and 3 were CKD-specific. The most commonly used PROMs in the PROs of pruritus, HRQoL, sleeping, and psychiatric symptoms were the visual analog scale (n = 47), dermatological life quality index (n = 8), Pittsburgh sleep quality index (n = 7), and Beck depression inventory (n = 3), respectively. The PROs and PROMs are common and effective tools for evaluating CKD-aP, but more high-quality studies and guidelines are needed to reach a clear consensus on their application.

Keywords: Chronic kidney disease-associated pruritus (CKD-aP); assessment; health-related quality of life (HRQoL); itching; patient-reported outcome measures (PROMs); patient-reported outcomes (PROs).

Figure 1

PRISMA flowchart describing the identification, selection, and inclusion of studies on PROMs assessment in CKD-aP.

Figure 2

Frequency of evaluation of PROs.

Figure 3

Frequency of evaluation of PROMs. (A) Frequency of PROMs used in pruritus assessment. (B) Frequency of PROMs used in HRQoL assessment. (C) Frequency of PROMs used in sleep disturbances assessment. (D) Frequency of PROMs used in psychiatric comorbid conditions assessment. (E) Frequency of PROMs used in other skin symptoms assessment. 4-IIQ, 4-item itch questionnaire; 5-DIS, 5-dimension itching scale; 12-PSS, 12-item pruritus severity scale; ADS-L, Allgemeine Depressionsskala-Langform; BDI, Beck depression inventory; CES-D, center for epidemiological studies depression scale; DLQI, dermatological life quality index; DPS, duo pruritus score; EQ-5D, EuroQol 5 dimensions questionnaire; FANLTC, functional assessment for non-life-threatening conditions tool; GAD-7, generalized anxiety disorder-7; HADS, hospital anxiety and depression scale; ISS, itch severity scale; Itch-MOS, itch medical outcomes study; KDQOL-36, Kidney Disease Quality of Life-36; NRS, numerical rating scale; ODS, overall dry skin score; PGIC, patient global impression of change; PS, pruritus score; PSQI, Pittsburgh sleep quality index; SADS, self-assessed disease severity; SF-12, short form-12; SF-36, short form-36; SRRC, scaling, roughness, redness, and cracks scoreTAS-20, Toronto alexithymia scale 20; UP-Dial, uraemic pruritus in dialysis patient questionnaire; VAS, visual analog scale; VRS, verbal rating scale; WI-NRS, 24–h Worst itching numeric rating scale.