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Kidney Week

Abstract: TH-PO244

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

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Rayner, Hugh C., Heart of England NHS Foundation Trust, Birmingham, WEST MIDLANDS, United Kingdom
  • Guebre Egziabher, Fitsum, Hospital Albert Michallon, La Tronche, 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-Ghamdi, Saeed, King Faisal Speciialist Hospital & Research Center-Jeddah, Jeddah, Saudi Arabia
  • Sukul, Nidhi, University of Michigan, Ann Arbor, Michigan, United States
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