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Kidney Week

Abstract: FR-PO427

Burden of CKD-Associated Pruritus and Adverse Clinical Outcomes in Patients Receiving Dialysis: The SCREAM Project

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Faucon, Anne-Laure, Karolinska Institutet, Stockholm, Sweden
  • Evans, Marie, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Carrero, Juan Jesus, Karolinska Institutet, Stockholm, Sweden
Background

Pruritus, a strong sensation of itching, is a common complain of patients on dialysis, but their prevalence and consequences are not well known. We aimed to quantify the burden of clinically recognized pruritus and associated adverse clinical outcomes in a region-representative cohort of patients on dialysis.

Methods

Observational study of all patients receiving maintenance dialysis in Stockholm, Sweden, during 2006-2021. Pruritus was identified by clinical diagnoses, two consecutive dispenses of pruritus-medications, or use of UV-therapy. Study outcomes were incident diagnoses of depression and sleep disorders, serious infection-related hospitalizations (composite of endocarditis, peritoneal dialysis-related peritonitis, hemodialysis / peritoneal dialysis-related catheter infection, sepsis due to Staphylococcus Spp., or skin infection), and all-cause mortality. Multivariable Cox regression models with time-varying exposures explored the association between prevalent/new-onset pruritus and adverse clinical outcomes.

Results

Among 3281 dialysis patients (median age 64 years, 66% men, 69% on hemodialysis, mean dialysis vintage 2.2 years), 456 (13.8%) had pruritus at enrollment. During median follow-up of 8.3 [IQR: 4.2-13.2] years, additional 637 (22.5%) patients developed pruritus. Prevalent and new-onset pruritus patients were at a higher risk of suffering sleep disorders (N=1294, HR: 2.02 [95%CI 1.70-2.41]), developing depression (N=752, HR: 1.70 [1.40-2.07]) and being hospitalized for serious infections (composite N=872, HR: 1.40 [1.23-1.60]), the latter attributed to higher risk of catheter-related infections, peritonitis and sepsis. No association was observed with endocarditis or all-cause mortality.

Conclusion

At least one third of dialysis patients suffer from CKD-associated pruritus during their lifetime. Patients with pruritus are at increased risk of infections, depression and sleep disorders.

Funding

  • Commercial Support – Vifor Pharma