# Pruritus in Hemodialysis Patients in a Sub‐Saharan African Country: Benin—Associated Skin Conditions and Other Factors in 2023 in Three Hemodialysis Centers

## TL;DR

This study explores the causes and risk factors for itchy skin in hemodialysis patients in Benin, finding that dry skin and long-term dialysis are key contributors.

## Contribution

The study identifies novel risk factors for pruritus in hemodialysis patients in a Sub-Saharan African context.

## Key findings

- Pruritus prevalence was 40.41% among hemodialysis patients.
- Severe xeroderma and prolonged hemodialysis duration increase pruritus risk.
- Oral antidiabetic use is associated with reduced pruritus risk.

## Abstract

Pruritus is a frequent and debilitating complication in hemodialysis patients. Its pathophysiology remains poorly understood. This study aimed to describe the factors associated with pruritus in three hemodialysis centers in 2023.

This was a prospective, descriptive, and analytical cross‐sectional study. It included 245 patients aged 18 years and older, undergoing hemodialysis for at least three months, hemodynamically stable, and who had provided informed consent. Pruritus intensity was assessed using the Itch‐Numeric Rating Scale (Itch‐NRS). Statistical analysis was performed using Stata 17, with a significance level set at p < 0.05.

The prevalence of pruritus among hemodialysis patients was 40.41%. The mean age of participants was 52.75 years, with a sex ratio of 1.78. Pruritus was most often mild to moderate (90.91%), generalized (48.48%), or diffuse (51.52%) and had been present for at least 1 year in 67.67% of cases. The most frequently associated dermatoses were xeroderma (88.88%), nail abnormalities (77.14%), and diffuse hyperpigmentation (27.27%).

Univariate analysis identified protective factors such as vitamin D supplementation, absence of anuria, absence of diffuse skin hyperpigmentation, absence of alopecia, and absence of nail abnormalities (p = 0.003–0.042; OR = 0.17–0.58). Multivariate analysis showed that prolonged duration of hemodialysis, the use of an arteriovenous fistula, severe xeroderma, and the presence of Beau’s lines (p ≤ 0.039) increased the risk of pruritus in hemodialysis patients. Conversely, the use of oral antidiabetic agents was significantly associated with a reduced risk of pruritus (p = 0.003; OR = 0.25).

Pruritus is a common and chronic condition in hemodialysis patients, adversely affecting their quality of life. The main risk factors identified were severe xeroderma, prolonged duration of hemodialysis, use of an arteriovenous fistula, and the presence of Beau’s lines, whereas the use of oral antidiabetic medications appeared to be protective. A better understanding of the pathophysiology of pruritus in hemodialysis patients could help improve its management and enhance patient comfort.