THE IMPACT AND MANAGEMENT OF PRURITUS IN A SATELLITE HAEMODIALYSIS UNIT - THE PATIENTS' PERSPECTIVE

Introduction:

Chronic kidney disease (CKD)-associated pruritus (CKD-aP) affects up to 80% of patients on haemodialysis and is associated with poorer health outcomes and quality of life.  There are relatively few guidelines for management of CKD-aP, with strongest evidence for kappa opioid agonist difelikefalin (DFK), more moderate evidence for gabapentinoids, and conflicting evidence for the optimisation of calcium homeostasis and inflammation.  This service evaluation examined the quality-of-life impact and management of CKD-aP in patients attending outpatient haemodialysis (HD) at a satellite unit in East London.

Methods:

The service evaluation was registered with the hospital trust's clinical effectiveness unit under audit ID 13081.  Questionnaires to assess extent and impact of CKD-aP were developed using the validated scales 5D itch score and Skindex-10 score respectively.  Further data were collected from the electronic patient record.  Data were analysed with IBM SPSS Statistics (Version 27).  

Results:

Of 123 patients, 56.1% experienced pruritus; 34.1% experienced at least moderate itch.  

Of the 69 patients experiencing pruritus, the median Skindex-10 score was 19/60 (IQR 9-34).  There was no significant association between 5D itch score or Skindex-10 score and age, gender, ethnicity, vintage on dialysis, presence or absence of diabetes, biochemical markers of mineral bone disease or inflammation or number of missed HD sessions.  

62.3% of patients with CKD-aP had not sought help from a healthcare professional and 33.3% were untreated.  Emollients were the most commonly used treatment and antihistamines were the most commonly used systemic treatment.  Only 7.25% of patients with CKD-aP were taking gabapentinoids; no patients were taking DFK.

Conclusions:

Pruritus was a prevalent symptom in our cohort, with considerable impact on quality-of-life measures.  Healthcare professionals should proactively ask about pruritus in order to identify patients who would benefit from treatment, and patient education regarding CKD-aP will empower patients to ask for help with their symptoms.  Further work will be undertaken to develop local guidelines for the management of CKD-aP, particularly with recent NICE approval of difelikefalin for this indication.  

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.