Patients with end-stage kidney disease receiving maintenance hemodialysis are at risk for uremia pruritus, a common and burdensome condition that contributes to the inability of patients to complete their prescribed hemodialysis sessions. Results of previous studies have demonstrated that shortening or skipping hemodialysis treatments increases the risk of mortality in patients with ESKD.
Johnson Lim Gomez, MD, and colleagues conducted a study designed to examine the extent to which pruritus contributes to patients shortening or skipping hemodialysis sessions. Results of the study were reported during a virtual poster session at ASN Kidney Week 2021 in a poster titled Shortened or Skipped Hemodialysis Sessions Attributed to Uremic Pruritus: A National Kidney Foundation Patient Survey.
From November 11 to 27, 2020, an online survey of adults ≥18 years of age across the United States was conducted using two links posted on the National Kidney Foundation Facebook page. The first 500 respondents with a valid email address were offered a $5 electronic Amazon gift card incentive.
Among the initial 2604 respondents, 1252 were excluded for partial study completion, 516 were excluded for not having kidney disease, and 144 were excluded for not receiving hemodialysis treatment, resulting in a study cohort of 692 respondents.
Compared with the 2018 results from the United States Renal Data System Annual Data Report, the cohort was younger and enriched for home hemodialysis and employment. Mean age of the current study cohort was 38.5 years, 46.8% were <35 years of age, 45.5% were female, 15% were Black or African American, 9% were Hispanic, 9% were American Indian, and 3% were Asian. Most (74.7%) were employed or attending school, 45.3% had 1 to 5 years of hemodialysis vintage, 81% were treated with in-center hemodialysis, and 19% were treated with home hemodialysis.
Pruritus was common among the survey respondents; 64.0% (n=428/669) self-reported itch described as at least somewhat intense on a Linkert scale, including 25.7% (n=172/669) of patients describing itch as very or extremely intense.
Approximately half of the respondents reported shortening or skipping a hemodialysis session due to pruritus at least some of the time; 55.6% (n=334/601) reported shortening a session and 50.4% (n=303/601) reported skipping a session. The patients who described the itch as very or extremely intense were more likely to skip or miss hemodialysis treatments.
Nephrologists were the most likely professionals among the hemodialysis care team to be identified by patients to talk with about itchy skin.
In conclusion, the authors said, “This survey cohort of hemodialysis patients showed pruritus leading to skipped or shortened hemodialysis sessions occurred in about half of the patients. The results support uremic pruritus as a significant cause of skipped or shortened hemodialysis sessions for the dialysis care team to consider.”