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Abstract: TH-PO243

Pruritus and Mortality in Hemodialysis Patients: Results from the International DOPPS

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Sukul, Nidhi, University of Michigan, Ann Arbor, Michigan, United States
  • Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Rayner, Hugh C., Heart of England NHS Foundation Trust, Birmingham, WEST MIDLANDS, United Kingdom
  • Urena Torres, Pablo A., Department of Dialysis, AURA Nord Saint Ouen and Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France
  • Csomor, Philipp, Vifor Fresenius Medical Care Renal Pharma Ltd., Glattbrugg, Switzerland
  • Schaufler, Thilo, Vifor Pharma Management Ltd., Glattbrugg, Switzerland
  • Wen, Warren, Cara Therapeutics, Stamford, Connecticut, United States
  • Menzaghi, Frederique, Cara Therapeutics, Inc., Stamford, Connecticut, United States
  • Hasegawa, Takeshi, Showa University, Yokohama, kanagawa, Japan
  • Chen, Yuqing, Peking University First Hospital, Beijing, China
  • Al Salmi, Issa, The Royal Hospital, Muscat, Oman
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

Chronic kidney disease-associated pruritus (CKD-aP) has been previously associated with poorer quality-of-life and increased risk of depression and death in hemodialysis (HD) patients. We sought to assess the association between pruritus and mortality in a large, contemporary, international cohort of HD patients.

Methods

We analyzed 25,916 HD patients from 21 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4-6 (2009-2018) who self-reported the degree to which they were bothered by itchy skin (5-category ordinal scale from “Not at all” to “Extremely”). We used Cox regression to investigate the association between pruritus and all-cause mortality, adjusted for confounders.

Results

The proportion of patients who were at least moderately bothered by pruritus was 37% overall, and ranged from 27% in Germany to 47% in the UK. The groups with more severe pruritus had lower mean hemoglobin and albumin, a higher proportion of catheter use, and a higher prevalence of cardiovascular comorbidities, diabetes, and psychiatric disorders. The death rate was 0.106/year over a median (IQR) follow-up of 17 (9, 27) months (4,063 deaths). Compared to the reference group of patients not at all bothered by itching, the adjusted mortality HR (95% CI) was 1.02 (0.93, 1.11) for somewhat bothered, 1.13 (1.03, 1.24) for moderately bothered, 1.08 (0.98, 1.21) for very much bothered, and 1.30 (1.15, 1.48) for extremely bothered (Figure).

Conclusion

Analyzing these recent data, survival was shorter for HD patients who were moderately-to-extremely affected by pruritus. These results underscore the importance of diagnosing, evaluating possible causes of, and treating CKD-aP, with the goal of reducing symptom severity, in hopes of improving patient outcomes.

Funding

  • NIDDK Support