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The pathophysiology of CKD-associated Pruritus is multifactorial and several causes have been implicated1

Toxin deposition

Increased release of pro-inflammatory cytokines from immune and skin cells

Peripheral neuropathy

Opioid receptor dysregulation on peripheral sensory neurons: imbalanced mu- and kappa-opioid receptors (MORs and KORs)

MODE OF DISEASE

4 OUT OF 10 HD PATIENTS MAY SUFFER FROM MODERATE TO SEVERE* CKD-ASSOCIATED PRURITUS2

In the Dialysis Outcomes and Practice Patterns Study (DOPPS) involving 23,264 haemodialysis (HD) patients from 21 countries:2

of all patients were bothered to some degree by itch

of all patients were moderately to severely bothered by itch

CKD-ASSOCIATED PRURITUS IS BOTH UNDER-RECOGNISED AND UNDER-REPORTED3,4

In DOPPS§ 1 in 4 HD patients with
CKD-associated Pruritus who were bothered by itch did not report it to their clinician4

69% of medical units
underestimated CKD-associated Pruritus3

CKD-ASSOCIATED PRURITUS IS MUCH MORE THAN JUST AN ITCH2,3,5

Reduced quality-of-life

Strong associations were observed between itch severity and poor physical and mental quality-of-life, depressive symptoms, and poor sleep quality.2

Due to the appearance of their skin and the urge to scratch, CKD-associated Pruritus patients may avoid social interactions.6

Increased health risks and increased strains on healthcare resources

Compared with CKD-associated Pruritus patients who were not bothered by itch, patients who were extremely bothered by itch:2

altHad higher rates of all-cause, cardiovascular-related, and infection-related hospitalisations
altHad a greater risk of all-cause mortality
effiWere more likely to withdraw from HD or miss HD sessions

CKD, chronic kidney disease; CKD-associated Pruritus, chronic kidney disease-associated pruritus; DOPPS, Dialysis Outcomes and Practice Patterns Study; HD, haemodialysis; IV, intravenous; KORs, kappa-opioid receptors; KDQOL, Kidney Disease Quality-of-Life; MORs, mu-opioid receptors.

*Severe CKD-associated Pruritus is defined as patients ‘very much’ and ‘extremely bothered’ by itching. Severity of itch was established using the question from the KDQOL-36 questionnaire: During the past 4 weeks to what extent were you bothered by itchy skin? Answers: not at all, somewhat, moderately, very much, extremely.
DOPPS Phases 4–6 was a prospective cohort study of 23,264 HD patients from 21 countries between 2009–2018. The primary clinical outcome was time to all-cause mortality; dialysis-related outcomes included withdrawal from dialysis and missed haemodialysis sessions; patient-reported outcomes included measure of health-related quality-of-life, depression and sleep quality.
In total, 37% of patients were moderately to extremely bothered by itch. This figure can be broken down into patients moderately
bothered (18%), very much bothered (12%), and extremely bothered (7%) by itch.
§DOPPS Phases 1–5 was prospective cohort study of 51,062 HD patients from up to 17 countries between 1996–2015. Pruritus data were collected from 35,452 of these HD patients. Analyses were adjusted for age, sex, dialysis vintage, 13 summary comorbidity measures, and country and facility clustering effects.

References:

1. Verduzco HA & Shirazian S. Kidney Int Re. 2020;5:1387–1402. 2. Sukul N, et al. Kidney Medicine. 2020;3(1):42–53. 3. Rayner HC, et al. Clin J Am Soc Nephrol. 2017;12:2000–2007. 4. Rayner HC, et al. Clin J Am Soc Nephrol. 2017;12:2000–2007. Supplementary Material. 5. Pisoni RL, et al. Nephrol Dial Transplant. 2006;21:3495–3505. 6. Silverberg JI, et al. AM J Clin Dermatol. 2018;19(5):759–769.

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