Patients with end-stage kidney disease on in-center hemodialysis commonly experience chronic kidney disease-associated pruritus (CKD-aP). The incidence of CKD-aP is approximately 40% of patients on hemodialysis. Novel agents for the treatment of CKD-aP have been identified in recent clinical trials.
Huei Hsun Wen, MD, and colleagues conducted a patient survey to examine the prevalence of uremic pruritus and its association with other symptoms in order to facilitate identification of patients who would most benefit from treatment.
Patients ≥18 years of age with a duration of in-center hemodialysis of ≥30 days were surveyed. The patients were receiving hemodialysis three times a week at the Mount Sinai Kidney Center (New York, New York). During the final 15 minutes of their hemodialysis treatments for 4 weeks, patients completed surveys covering the presence of 21 different symptoms (nausea, vomiting, shortness of breath, itch, dry skin, edema, muscle soreness, concentration, diarrhea, appetite, cough, fatigue, dry mouth, restless leg syndrome, bone pain, constipation, cramp, chest pain, intradialytic hypertension, dizziness, headache). Multiple correspondence analysis was used to identify associations between symptoms and group individuals with similar symptom profiles.
A total of 97 hemodialysis patients completed the survey. Of those, 41% (n=40) reported itching at least once during the study period. There were no significant differences in patient characteristics between patients who reported itching and those who did not report itching. Of the 40 patients who reported itching, on average they reported itching on 30% of their treatments.
On multiple correspondence analysis, the symptoms most closely correlated with itching were dry skin and fatigue (Spearman correlation coefficient for dry skin, 0.63, and 0.37 for fatigue [P<.001 for both]). There were no obvious patient groupings using symptom data only.
In conclusion, the researchers said, “CKD-aP affects a large proportion of patients on hemodialysis, occurs repeatedly, and clusters with dry skin and fatigue.”