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Chronic kidney disease-associated pruritus (CKDaP) and skin dryness sensation (SDS) are some of the most discomforting symptoms for hemodialysis (HD) patients. CKDaP has a great impact on quality of life and is highly prevalent among them. The pathophysiology is still unknown, and the condition is underdiagnosed. This lack of recognition leads to the lack of treatment for this symptom. Therefore, the present work aims to understand the prevalence of CKDaP and the SDS, as well as its assistance, in HD patients.
This is a cross-sectional study, carried out through structured interviews, from September 2021 to September 2023, in three dialysis centers in the state of Paraíba, Brazil. The individuals included in the research were over 18 years old. They had been on HD for more than three months.
With an average age of 51.2 ±13.7 years old, 176 patients were interviewed. The average time on HD was 39.1 ± 38 months. 54.5% of participants were male and 96.6% underwent HD through the public health system. During the last month of the data collection, around 32.3% of patients reported CKDaP. Of those, 8.2% reported no discomfort while 61.2% reported the maximum possible discomfort. 36.9% did not seek medical assistance for the condition and 56.5% sought out a nephrologist. When a doctor was contacted, 52.8% reported having received all the necessary attention, while 19.4% claimed not having received any attention. There was no statistically significant correlation between the severity of CKDaP and the demand for medical assistance (p=0.236). 55.8% of patients with CKDaP were male, 46.1% reported SDS; 44.2% had difficulty falling asleep and 34.6% had difficulty staying asleep; 40.3% felt nervous, 44.2% were sad, 51.9% anxious and 30.7% irritated. In the inductive analysis of the data, there was no statistically significant correlation between CKDaP and co-morbidities, sex (p=0.659), age (p=0.748), anxiety (p=0.160), irritation (p=0.721), difficulty falling asleep (p=0.534), difficulty in maintaining sleep (p=0.165) and SDS (p=0.143). The severity of CKDaP was also not associated with the SDS (p=0.146). Regarding the SDS, 40.3% reported the symptoms. Of these, 20% reported no discomfort and 30.9% the maximum possible discomfort. 61.5% did not seek assistance and 23.4% were evaluated by a nephrologist. When the doctor was contacted, 51.9% said they had received all the necessary attention, while 33.3% reported not having received any attention. Of the patients with SDS, 55% were female, 47.8% had difficulty falling asleep and 32.3% had difficulty staying asleep; 36.6% felt nervous, 46.4% were sad, 50.7% were anxious and 39.4% were irritated. The SDS did not show a statistically significant correlation with co-morbidities, gender (p=0.330), age (p=0.369), feeling of sadness (0.161), difficulty in initiating sleep (p=0.256) and difficulty of maintaining sleep (p=0.267). On the other hand, there was a statistical correlation between the SDS and the feeling of anxiety (p=0.030) and irritation (p=0.008).
The SDS and CKDaP are common symptoms in HD patients in Brazil. A significant portion of patients do not report their symptoms to their doctor. When they do, a considerable portion report not receiving the necessary attention.