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Clin J Am Soc Nephrol. 2019 May 7;14(5):673-681. doi: 10.2215/CJN.09600818. Epub 2019 Apr 11.

Pruritus and Patient Reported Outcomes in Non-Dialysis CKD.

Author information

1
Department of Internal Medicine, Division of Nephrology and nsukul@med.umich.edu.
2
Centre for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris Sud, Université Versailles Saint Quentin, UMRS 1018, Villejuif, France.
3
Arbor Research Collaborative for Health, Ann Arbor, Michigan.
4
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
5
Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil.
6
Division of Nephrology and Hypertension, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan.
7
Department of Internal Medicine, Division of Nephrology and.
8
Nephrology Department, Lyon Sud Hospital, Lyon University, Laboratoire de Recherche en Cardiovasculaire, Métabolisme, diabétologie et Nutrition INSERM U 1060, Pierre Benite, France; and.
9
Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, United Kingdom.

Abstract

BACKGROUND AND OBJECTIVES:

Among patients on hemodialysis, pruritus has been associated with poorer mental and physical quality of life, sleep quality, depression, and mortality. We evaluated patients with nondialysis CKD to describe the prevalence of pruritus, identify associated factors, and investigate associations with patient-reported outcomes.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

Using cross-sectional data from patient questionnaires in the CKD Outcomes and Practice Patterns Study (CKDopps), we asked patients with CKD stages 3-5 (nondialysis) from the United States, Brazil, and France to identify how much they were bothered by pruritus. Response options ranged from "not at all" to "extremely." Log-Poisson regression, yielding prevalence ratios, was used to evaluate associations of moderate-to-extreme pruritus with patient characteristics, CKD stage, self-reported depression symptoms, and restless sleep. Mixed linear regression was used to examine associations between pruritus and physical and mental component summary scores, with lower scores indicating poorer quality of life.

RESULTS:

Of the 5658 CKDopps patients enrolled in the United States, Brazil, and France, 3780 (67%) answered the pruritus question. The prevalence of moderate-to-extreme pruritus was 24%, and more likely in older patients, women, and those with stage 5 CKD, lung disease, diabetes, and physician-diagnosed depression. In adjusted models, patients with moderate pruritus had physical and mental component summary scores 3.5 (95% confidence interval [95% CI], -4.6 to -2.3) and 2.3 (95% CI, -3.2 to -1.5) points lower, respectively, than patients without pruritus, and they also had a higher adjusted prevalence of patient-reported depression (prevalence ratio, 1.83; 95% CI, 1.58 to 2.11) and restless sleep (prevalence ratio, 1.69; 95% CI, 1.49 to 1.91) compared with patients without pruritus. These patient-reported outcomes were progressively worse with increasing severity of pruritus.

CONCLUSIONS:

Our findings demonstrate high prevalence of pruritus in nondialysis CKD, as well as strong associations of pruritus with poor health-related quality of life, self-reported depression symptoms, and self-reported poor sleep.

KEYWORDS:

Cross-Sectional Studies; Linear Models; Lung Diseases; Patient Reported Outcome Measures; Prevalence; Pruritus; Renal Insufficiency, Chronic; Surveys and Questionnaires; Uremic pruritus; chronic kidney disease; depression; diabetes mellitus; dialysis; quality of life

PMID:
30975656
PMCID:
PMC6500934
[Available on 2020-05-07]
DOI:
10.2215/CJN.09600818

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