New research reveals that pruritus, or itchy skin, affects a substantial percentage of patients with chronic kidney disease (CKD). The study, which appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology(CJASN), also indicates which patients are more likely to experience pruritus, and demonstrates that pruritus may affect quality of life and sleep.
In studies of patients on dialysis, pruritus is common and has various negative effects on health
and well-being. To examine the issue in patients with less severe kidney disease, Nidhi Sukul, MD (University of Michigan) and her colleagues provided questionnaires to US, Brazilian, and French patients with stages 3-5 CKD (estimated glomerular filtration rate of 60 mL/min/1.73 m²) who were not on dialysis.
A total of 3,780 patients answered a question about pruritus. The prevalence of moderate-to-extreme pruritus was 24% and was more likely in older patients, females, and those with non-dialysis stage 5 CKD, lung disease, diabetes, and physician-diagnosed depression. In this questionnaire, compared with patients without pruritus, patients with pruritus indicated poorer mental and physical quality of life and a greater likelihood of experiencing depression and restless sleep. These patient-reported outcomes were progressively worse with increasing severity of pruritus.
"One of the main goals of managing chronic disease is alleviating symptoms; however, this is only possible when we are aware of the suffering patients endure," said Dr. Sukul. "This research gives us a uniquely international look at how important it is to ask our patients with chronic kidney disease if and how they are affected by pruritus. Some drugs have been shown to largely improve pruritus-related symptoms for a substantial percentage of patients, but even if we do not have a universally effective treatment for pruritus, recognizing that pruritus ails our patients and affects their quality of life will make them feel heard and enhance the patient-physician relationship in discussing approaches that may help provide relief from pruritus."
Nidhi Sukul, Elodie Speyer, Charlotte Tu, Brian A. Bieber, Yun Li, Antonio A. Lopes, Koichi Asahi, Laura Mariani, Maurice Laville, Hugh C. Rayner, Bénédicte Stengel, Bruce M. Robinson, Ronald L. Pisoni. Pruritus and Patient Reported Outcomes in Non-Dialysis CKD. Clinical Journal of the American Society of Nephrology, 2019; CJN.09600818 DOI: 10.2215/CJN.09600818