Kidney Week

Abstract: TH-PO244

Pruritus and Patient-Reported Outcomes (PROs): Associations Between the Skindex-10 and PROs in Hemodialysis Patients

Session Information

• Hemodialysis and Frequent Dialysis - II
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Angelo Karaboyas,

• Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Ronald L. Pisoni,

• Rayner, Hugh C., Heart of England NHS Foundation Trust, Birmingham, WEST MIDLANDS, United Kingdom

Hugh C. Rayner,

• Guebre Egziabher, Fitsum, Hospital Albert Michallon, La Tronche, France

Fitsum Guebre Egziabher,

• Csomor, Philipp, Vifor Fresenius Medical Care Renal Pharma Ltd., Glattbrugg, Switzerland

Philipp Csomor,

• Schaufler, Thilo, Vifor Pharma Management Ltd., Glattbrugg, Switzerland

Thilo Schaufler,

• Wen, Warren, Cara Therapeutics, Stamford, Connecticut, United States

Warren Wen,

• Menzaghi, Frederique, Cara Therapeutics, Inc., Stamford, Connecticut, United States

Frederique Menzaghi,

• Hasegawa, Takeshi, Showa University, Yokohama, KANAGAWA, Japan

Takeshi Hasegawa,

• Chen, Yuqing, Peking University First Hospital, Beijing, China

Yuqing Chen,

• Al-Ghamdi, Saeed, King Faisal Speciialist Hospital & Research Center-Jeddah, Jeddah, Saudi Arabia

Saeed Al-Ghamdi,

• Sukul, Nidhi, University of Michigan, Ann Arbor, Michigan, United States

Nidhi Sukul,

Background

Chronic kidney disease-associated Pruritus (CKD-aP) is a prevalent and distressing symptom in hemodialysis (HD) patients that affects Health Related Quality of Life (HR-QoL), but remains poorly characterized.

Methods

We analyzed 5418 HD patients from 17 countries in phase 5 (2013) of the Dialysis Outcomes and Practice Patterns Study (DOPPS) who self-reported being bothered by itchy skin (yes/no). “No” responses were assigned a Skindex-10 (SK-10) score of 0. Patients responding “Yes” then answered 10 questions about the frequency (0-6 scale) they were distressed by various aspects of CKD-aP. We investigated the association between SK-10 score (0-60 range; higher = more bothered) and 4 outcomes: (1) Physical and (2) Mental Component Summary (PCS; MCS) scores from the SF-12 (higher score = better HR-QoL) using linear mixed models; (3) Center for Epidemiologic Studies-Depression (CES-D) score ≥10 (indicative of depressive symptoms) and (4) Poor sleep quality (≥3 nights/week of restless sleep), both using modified Poisson regression.

Results

Mean SK-10 score was 12.2 overall and 27.4 among those affected by CKD-aP (Yes responders); 45% of patients had SK-10 score >0, including 17% with 1-20, 19% with 21-40, and 9% with 41-60. In adjusted models, lower PCS and MCS scores, poorer sleep quality, and greater likelihood of CES-D ≥10 were observed with increasingly higher SK-10 scores (Figure). SK-10 was highly correlated (r=0.71) with a separate summary question about the extent patients were bothered by itchy skin in the past 4 weeks.

Conclusion

Pruritus severity, reflected by the SK-10, was clearly and monotonically associated with other PROs including physical and mental HR-QoL, depression, and sleep quality, further emphasizing the importance of identifying and treating CKD-aP. Given its strong correlation with the SK-10 score, the single summary question could make routine assessment of pruritus in HD patients more concise and efficient.

Funding

• NIDDK Support – This analysis was supported by Vifor, Relypsa, and Cara Therapeutics. The DOPPS Program is supported by Amgen (since 1996, founding sponsor), Kyowa Hakko Kirin (since 1999 for Japan DOPPS), and Baxter Healthcare Corp. Additional support for specific projects and countries is provided by Akebia Therapeutics, AstraZeneca, European Renal Association-European Dialysis & Transplant Association (ERA-EDTA), Fibrogen, Fresenius Medical Care Asia-Pacific Ltd, Fresenius Medical Care Canada Ltd, German Society of Nephrology (DGfN), Italian Society of Nephrology (SIN), Janssen, Japanese Society for Peritoneal Dialysis (JSPD), Kidney Care UK, MEDICE Arzneimittel Pütter GmbH & Co KG, Otsuka America, Proteon Therapeutics, the Association of German Nephrology Centres, and Vifor Fresenius Medical Care Renal Pharma. Public funding and support is provided for specific DOPPS projects, ancillary studies, or affiliated research projects by National Health & Medical Research Council (NHMRC) in Australia, Belgian Federal Public Service of Public Health in Belgium, Cancer Care Ontario (CCO) through the Ontario Renal Network (ORN) in Canada, French National Institute of Health and Medical Research (INSERM) in France, Thailand Research Foundation (TRF), Chulalongkorn University Matching Fund, King Chulalongkorn Memorial Hospital Matching Fund, and the National Research Council of Thailand (NRCT) in Thailand, National Institute for Health Research (NIHR) via the Comprehensive Clinical Research Network (CCRN), and Kidney Research UK (KRUK) in the United Kingdom, and the Agency for Healthcare Research and Quality (AHRQ) and National Institutes of Health (NIH) in the US. All support is provided without restrictions on publications. All grants are made to Arbor Research Collaborative for Health and not to Mr. Karaboyas directly.