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Kidney Week

Abstract: PO2272

Risk Factors for Incident Pruritus in Patients with CKD Not on Dialysis

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Wulczyn, Kendra E., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Kalim, Sahir, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Rhee, Eugene P., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Shafi, Tariq, The University of Mississippi Medical Center, Jackson, Mississippi, United States
Background

Pruritus is common in patients with CKD not on dialysis, but its incidence and risk factors have not been rigorously evaluated.

Methods

Using data from the Chronic Renal Insufficiency Cohort (CRIC) study, we identified 2,164 participants that were pruritus free at baseline. Pruritus was assessed annually by the Kidney Disease Quality of Life instrument. We used Cox models adjusted for age, sex, race, ethnicity, diabetes, smoking status, and opioid use to analyze the association of pruritus with baseline estimated GFR, categorized as <30, 30 to <45, 45 to <60, and ≥60 mL/min/1.73 m2. In an exploratory analysis, markers of bone-mineral metabolism and inflammation, possible mediators of the association between eGFR and pruritus, were added to the models to evaluate their association with risk of pruritus.

Results

The mean age of participants was 58 years, 43% were women, and 43% Black. During a median follow-up of 6.0 years, 684 participants developed moderate-to-severe pruritus, with an overall unadjusted incidence rate of 4.6 per 100 person-years. The 5-year unadjusted cumulative incidence of pruritus was: overall 21%, eGFR ≥60 18%, eGFR 45 to <60 20%, eGFR 30 to <45 24%, and eGFR <30 20%. In the fully adjusted model, compared to eGFR ≥60, an eGFR of 30-45 was associated with a 39% (95% CI 1.08 – 1.80) higher risk of pruritus, and an eGFR <30 was associated with a 56% (95% CI 1.15 – 2.11) higher risk of pruritus (Figure 1). Female sex, diabetes, current smoking, and opioid use were associated with increased risk of pruritus, independent of eGFR. Notably, serum albumin and c-reactive protein were independently associated with pruritus, whereas calcium, phosphorous, and parathyroid hormone were not.

Conclusion

A significant proportion of patients with CKD develop pruritus, even at modestly reduced eGFR ≤ 45 mL/min/1.73 m2. Careful assessment and management of pruritus should be considered as a part of routine CKD care.

Adjusted cumulative incidence of pruritus by eGFR in the CRIC study

Funding

  • NIDDK Support