# Chronic Kidney Disease-Associated Pruritus in Patients Undergoing Haemodialysis—A Cross-Sectional Study

## TL;DR

This study finds that 40% of patients on hemodialysis suffer from chronic kidney disease-related itching, which is linked to depression but not to quality of life or sleep issues.

## Contribution

The study identifies a significant prevalence of CKD-associated pruritus and its correlation with depression in hemodialysis patients.

## Key findings

- 40% of hemodialysis patients reported chronic kidney disease-associated pruritus.
- Severe CKD-aP was significantly correlated with higher depression scores.
- No significant link was found between CKD-aP and health-related quality of life.

## Abstract

Background and Objectives: Chronic kidney disease-associated pruritus (CKD-aP) is a burdensome symptom associated with impaired patient-reported outcomes. There is a paucity of research in this area with unclear aetiology, under-reporting of this symptom, and limited treatment options and management strategies in clinical settings. The objective of this study was to investigate the prevalence of CKD-aP, patient and dialysis-related factors associated with the occurrence of CKD-aP, and the correlation between CKD-aP severity and quality of life, sleep, anxiety, and depression. Materials and Methods: This cross-sectional study was conducted in 88 adult (≥18 years) patients undergoing haemodialysis at the outpatient dialysis centre at a major Australian tertiary care university teaching hospital. Demographic- and dialysis-related factors were obtained from electronic medical records and/or patients, while patient outcomes were determined from the self-reported questionnaires; 5-D itch scale, EQ-5D-5L, Patient Health Questionnaire-9, and Beck Anxiety Inventory. We compared demographic, patient-, and dialysis-related factors associated with CKD-aP. Results: Out of 88 patients, 67 (76%) agreed to participate in the study. In total, 27 patients (40%) reported having CKD-aP. Most participants experienced moderate CKD-aP severity (n = 12), followed by severe or very severe (n = 9) and mild (n = 6) symptoms. Whilst there was no significant difference in the demographic characteristics, number of medications, dialysis vintage, and Kt/V, a higher number of pruritic participants experienced obstructive sleep apnoea. There was a statistically significant correlation between CKD-aP severity and depression scores (p = 0.009). However, there were no significant correlation between CKD-aP and HRQOL (p = 0.506). The correlations between CKD-aP severity and outcomes such as sleep and anxiety were also not statistically significant, although they were marginally close (p = 0.069 and p = 0.095, respectively). Conclusions: This study reports a substantial prevalence of CKD-aP reported among patients undergoing HD and the association of severe CKD-aP with depression. Despite the limitation of a small sample size from a single dialysis centre, our findings suggest that the severity of CKD-aP may have implications for patient-reported outcomes. This warrants further investigation in larger-scale studies to better understand the association and optimise outcomes.