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Abstract: TH-PO1138

Association of CKD-Associated Pruritus (CKDaP) with More Sleep Disorders, Increased Pain, and Worse Fatigue in US Hemodialysis Patients

Session Information

  • Late-Breaking Posters
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Desai, Tejas, Vifor Pharma Management Ltd, Glattbrugg, Zurich, Switzerland
  • Lasky, Rachel A., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • Malhotra, Kunal, University of Missouri System, Columbia, Missouri, United States
  • Arens, Hans-Juergen, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • Oliveira, Juliana H., Vifor Pharma Management Ltd, Glattbrugg, Zurich, Switzerland
  • Anger, Michael S., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States

Patients & their advocates emphasize symptom-based management for those afflicted with ESKD. There is an active call-to-action for Nephrology healthcare providers (NHCPs) to provide a holistic treatment plan: one that equally prioritizes symptom-based & biochemically-focused care. Three symptoms ESKD patients experience are sleep disorders, pain, & fatigue. These components are part of a cluster of symptoms known as SPADE in the Nephrology literature. This study investigates the association of CKDaP, an under– recognized & reported symptom, with these components.


A retrospective analysis of 81310 difelikefalin-naïve, >30-day hemodialysis vintaged in-center patients were stratified into the 5 validated groups of CKDaP burden descriptors in question 20 of the KDQOL-36 instrument. The burden of sleep disorder, pain, & fatigue were independently measured using questions 6, 8, & 25 of the KDQOL-36, respectively. Scores were re-coded from 0 (highest burden) to 100 based on the Rand Corporation’s survey scoring instructions. ANOVA & logistic regression were used across pruritic levels. Mean (SD) are reported.


Nearly 58% of patients experienced moderate or greater pruritic burden. Those patients with a greater CKDaP burden were statistically likely to have worse sleep, fatigue, & pain, both independently and in aggregate (table).


This data shows a strong association of CKDaP with 1) sleep disorders, 2) pain, & 3) fatigue. Patients afflicted with CKDaP endure a greater individual & aggregate symptom burden than those without. NHCPs who detect CKDaP & quantify its burden can potentially identify patients experiencing a) numerically higher-than-expected & b) more severe co-morbidities.


  • Commercial Support – CSL Vifor