Work

Chronic kidney disease associated pruritus and healthcare resource utilization in European hemodialysis patients: results from an electronic patient-reported outcome survey

Year: 2025

Type: article

Abstract: BACKGROUND: Chronic kidney disease-associated pruritus (CKD-aP) is highly prevalent among hemodialysis (HD) patients, yet frequently underreported and underdiagnosed. While CKD-aP is associated with adverse patient-reported and clinical outcomes, the relationship between incident, persistent, and resolving CKD-aP rather than only severity and healthcare resource utilization (HCRU) has not been well explored. METHODS: We analyzed 2,631 electronic patient-reported outcome (ePRO) surveys from 747 HD patients in six European countries participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 7 (2021–2023). Patients completed surveys every three months for up to 18 months. Logistic regression estimated associations of pruritus severity and evolution with outcomes including self-reported pruritus treatment, non-nephrologist physician visits, and a composite of hospitalization and emergency room (ER) visit within three months. RESULTS: Within three months of pruritus assessment, patients moderately bothered by pruritus had ER visit, hospitalization, and skin infection rates of 4%, 12%, and 11%, respectively; those very much or extremely bothered had rates of 10%, 15%, and 6%, compared to 5%, 8%, and 4% in patients not at all bothered. Patients developing incident pruritus over three months were more likely to report a skin infection than those without pruritus (OR = 2.34, 95% CI: 1.11, 4.90). Patients very much or extremely bothered were most likely to visit a dermatologist (13%), especially those persistently bothered three months later. Use of over-the-counter oral medications (e.g., antihistamines) was highest among patients very much or extremely bothered (21%) and those persistently bothered. CONCLUSION: Despite high symptom burden, most patients with bothersome CKD-aP remained untreated. High prevalences of ER visits, hospitalization, and skin infection among patients bothered by itch in cross-sectional and longitudinal analyses suggest identifying incident and persistent CKD-aP may be as important as quantifying severity, arguing for serial measurement and intervention at lower severity to prevent downstream HCRU.

Source: BMC Nephrology

DOI: 10.1186/s12882-025-04655-6