Itchy Skin Affects the Health and Quality of Life of Many Patients with Kidney Disease

Highlights

• The prevalence of moderate-to-extreme pruritus in patients with non-dialysis chronic kidney disease was 24% and was more likely in older patients, women, and in those with advanced kidney disease, among other health conditions.
• More severe pruritus was associated with progressively poorer measures of quality of life and a higher likelihood of self-reported depression and restless sleep.

Newswise — Washington, DC (April 11, 2019) — 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 ≤ 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.” 

Study co-authors include Elodie Speyer, PhD, Charlotte Tu, DrPH, Brian Bieber, MPH, MS, Yun Li, PhD, Antonio A. Lopes MD, MPH, PhD, Koichi Asahi MD, PhD, FJSIM, Laura Mariani, MD, MS, Maurice Laville, MD, Hugh C. Rayner, MD, FRCP, Bénédicte Stengel, MD, PhD, Bruce M. Robinson, MD, MS, and Ronald L. Pisoni, PhD, MS.

Disclosures: B Bieber, Pisoni, B Robinson, and C Tu are employees of Arbor Research Collaborative for Health and all support is provided without restrictions on publications; all funds are made to Arbor Research Collaborative for Health and not directly to the authors. B Stengel coordinates the CKD-REIN study supported by Amgen, Baxter, Fresenius Medical Care, GlaxoSmithKline (GSK), Merck Sharp & Dohme-Chibret (MSD France), Lilly France, Otsuka Pharmaceutical, Vifor Fresenius, and Sanofi-Genzyme. The other authors declare that they have no competing interests.

The article, entitled “Pruritus and Patient Reported Outcomes in Non-Dialysis CKD,” will appear online at http://cjasn.asnjournals.org/ on April 11, 2019, doi: 10.2215/CJN.09600818.

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