Pruritus affects many patients undergoing
hemodialysis (HD). In this study,
pruritus and its relationship to morbidity, quality of life (QoL), sleep quality, and patient laboratory measures were analyzed in a large sample of Japanese patients undergoing HD. Severity of patient-reported
pruritus symptoms experienced during a 4-week period was collected from 6480 Japanese patients undergoing HD in three phases of the Dialysis Outcomes and Practice Patterns Study (DOPPS; 1996-2008; 60-65 study facilities/phase). Adjusted linear and logistic regressions were used to identify associations of
pruritus with treatment parameters and QoL outcomes. Adjusted Cox regressions examined the influence of
pruritus severity on mortality. Moderate to extreme
pruritus was experienced by 44% of prevalent patients undergoing HD in the Japanese Dialysis Outcomes and Practice Patterns Study. Many patient characteristics were significantly associated with
pruritus, but this did not explain the large differences in
pruritus among facilities (20-70%).
Pruritus was slightly less common in patients starting HD than in patients on dialysis >1 year. Patients with moderate to extreme
pruritus were more likely to feel drained (adjusted odds ratio = 2.2-5.8, P < 0.0001), have poor sleep quality (adjusted odds ratio = 1.9-3.7, P < 0.0001), and have QoL mental and physical composite scores 2.3-6.7 points lower (P < 0.0001) than patients with no/mild
pruritus.
Pruritus in patients undergoing HD was associated with a 23% higher mortality risk (P = 0.09). The many poor outcomes associated with
pruritus underscore the need for better therapeutic agents to provide relief for the 40-50% of prevalent patients undergoing HD substantially affected by
pruritus.
Pruritus in new patients with
end-stage renal disease likely results from
uremia or pre-existing conditions (not HD per se), indicating the need to understand development of
pruritus before
end-stage renal disease.