Journal
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume 14, Issue 5, Pages 673-681Publisher
AMER SOC NEPHROLOGY
DOI: 10.2215/CJN.09600818
Keywords
Uremic pruritus; chronic kidney disease; depression; quality of life; Patient Reported Outcome Measures; Cross-Sectional Studies; Prevalence; Linear Models; Surveys and Questionnaires; dialysis; Renal Insufficiency; Chronic; Pruritus; diabetes mellitus; Lung Diseases
Categories
Funding
- Agence Nationale de la Recherche
- 2010 national Programme Hospitalier de Recherche Clinique
- Amgen
- Fresenius Medical Care
- Baxter
- Wissenschaftliches Institut fur Nephrologie of the Verband Deutsche Nierenzentren
- Practical Research Project for Renal Diseases from Japan Agency for Medical Research and Development
- GlaxoSmithKline
- Merck Sharp & Dohme-Chibret (France)
- Lilly France
- Otsuka Pharmaceutical
- Vifor Fresenius
- Sanofi-Genzyme
- Keryx
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Background and objectivesAmong patients on hemodialysis, pruritus has been associated with poorer mental and physical quality of life, sleep quality, depression, and mortality. We evaluated patients with nondialysis CKD to describe the prevalence of pruritus, identify associated factors, and investigate associations with patient-reported outcomes.Design, setting, participants, & measurementsUsing cross-sectional data from patient questionnaires in the CKD Outcomes and Practice Patterns Study (CKDopps), we asked patients with CKD stages 3-5 (nondialysis) from the United States, Brazil, and France to identify how much they were bothered by pruritus. Response options ranged from not at all to extremely. Log-Poisson regression, yielding prevalence ratios, was used to evaluate associations of moderate-to-extreme pruritus with patient characteristics, CKD stage, self-reported depression symptoms, and restless sleep. Mixed linear regression was used to examine associations between pruritus and physical and mental component summary scores, with lower scores indicating poorer quality of life.ResultsOf the 5658 CKDopps patients enrolled in the United States, Brazil, and France, 3780 (67%) answered the pruritus question. The prevalence of moderate-to-extreme pruritus was 24%, and more likely in older patients, women, and those with stage 5 CKD, lung disease, diabetes, and physician-diagnosed depression. In adjusted models, patients with moderate pruritus had physical and mental component summary scores 3.5 (95% confidence interval [95% CI], -4.6 to -2.3) and 2.3 (95% CI, -3.2 to -1.5) points lower, respectively, than patients without pruritus, and they also had a higher adjusted prevalence of patient-reported depression (prevalence ratio, 1.83; 95% CI, 1.58 to 2.11) and restless sleep (prevalence ratio, 1.69; 95% CI, 1.49 to 1.91) compared with patients without pruritus. These patient-reported outcomes were progressively worse with increasing severity of pruritus.ConclusionsOur findings demonstrate high prevalence of pruritus in nondialysis CKD, as well as strong associations of pruritus with poor health-related quality of life, self-reported depression symptoms, and self-reported poor sleep.
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