Kidney Week

Abstract: TH-PO322

Management of Uremic Pruritus in Hemodialysis: Effectiveness of a Quality Improvement Treatment Algorithm

Session Information

• Dialysis: Cost, Socioeconomics, Quality of Life
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Tennankore, Karthik K., Dalhousie University/NS Health Authority, Halifax, Nova Scotia, Canada

Karthik K. Tennankore,

• Westby, Erin Patricia, Dalhousie University/NS Health Authority, Halifax, Nova Scotia, Canada

Erin Patricia Westby,

• Mccarron, Kailee L., Nova Scotia Health Authority, Halifax, Nova Scotia, Canada

Kailee L. Mccarron,

• Wood, Marsha, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada

Marsha Wood,

• Quraishi, Tabassum ata, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada

Tabassum ata Quraishi,

• Wilson, Jo-Anne S., Dalhousie University/NS Health Authority, Halifax, Nova Scotia, Canada

Jo-Anne S. Wilson,

• Tran, Jaclyn Y., Nova Scotia Health Authority, Halifax, Nova Scotia, Canada

Jaclyn Y. Tran,

• Vinson, Amanda Jean, Dalhousie University/NS Health Authority, Halifax, Nova Scotia, Canada

Amanda Jean Vinson,

• Silver, Samuel A., Queen's University, Kingston, Ontario, Canada

Samuel A. Silver,

Background

Uremic pruritus (UP) is highly prevalent among dialysis patients and associated with significant morbidity. However, management of UP is inconsistent across centres and many patients remain inadequately treated. The purpose of this study was to analyze the effectiveness of a UP treatment algorithm for chronic dialysis patients.

Methods

We analyzed a cross-section of in-center hemodialysis patients at a tertiary care center and assessed pruritus character (localized or generalized) and severity (0; no itch to 10; worst imagineable itch) using a numerical rating scale (NRS). Those with generalized pruritus rated as moderate to severe (NRS ≥4) were entered into a treatment algorithm consisting of hydrous emollients (all patients) and step-wise use of a topical agent (menthol 0.5%/camphor 0.5% cream), gabapentin (dose increased from 100-300 mg 3X/week) and UV-light. UP severity was recaptured at entry into the algorithm, and assessed at one month after the topical agent and two week intervals after each dose increase of gabapentin.

Results

Overall, 64/196 patients (33%) rated their pruritus as ≥4, and 56/64 entered the algorithm. A total of 39/56 patients (70%) had a persistent pruritus score of ≥4 on reassessment and were prescribed the topical agent; 16/39 patients had a complete response at one month post initiation, 2/39 could not afford the topical, 2/39 developed side effects necessitating discontinuation and 3/39 did not fill the prescription due to other delays. A total of 11 non-responders/non-users of the topical agent received gabapentin; 3/11 patients had a complete and sustained pruritus score of <3 at last follow-up while 3/11 patients failed to respond and were referred for UV light treatment. The remainder had not completed titration of gabapentin or experienced spontaneous remission. Overall, the mean pruritus score fell from 6.5 ± 2.1 to 2.9 ± 1.9 (P<0.001) for those who initiated treatment with the topical agent and had an assessment of their pruritus severity (N=31/39) at four months.

Conclusion

Implementation of a treatment algorithm for UP management effectively reduced UP severity in a cross-section of in-center hemodialysis patients. Future external validation of the algorithm is needed prior to widespread implementation.