PREVALENCE AND LIFESTYLE IMPACT OF CHRONIC KIDNEY DISEASE–ASSOCIATED PRURITUS: A CROSS-SECTIONAL STUDY OF ASSOCIATIONS WITH CLINICAL, BIOCHEMICAL, AND TREATMENT FACTORS

Chronic kidney disease associated pruritus (CKD-aP) remains a significant and often burdensome symptom among patients receiving maintenance haemodialysis. Reported prevalence differs notably between studies, reflecting both population heterogeneity and methodological variability. Although its underlying pathophysiological mechanisms are not yet fully elucidated, current evidence suggests involvement of multiple comorbid conditions and systemic metabolic imbalances. The diversity of contributing factors and the lack of a clearly defined pathophysiological pathway underscore the importance of personalized evaluation and targeted therapeutic strategies.

This study aims to assess the prevalence of  CKD-associated pruritus among haemodialysis patients and to examine its effects on sleep quality, social interaction, and patients' ability to tolerate itch. Furthermore, it seeks to assess associations between CKD-aP and various clinical, biochemical, and treatment-related variables, with the goal of informing more precise and effective symptom management strategies.

In this cross-sectional analysis, 106  haemodialysis patients were evaluated for CKD-aP  through a structured questionnaire, which included patient-reported outcomes on itch severity and its impact, as well as the Worst Itch Numerical Rating Scale (WI-NRS). Relevant clinical, biochemical, and pharmacological data were retrospectively collected from national electronic health records. Multivariable logistic regression was conducted to identify independent factors associated with pruritus, accounting for demographic characteristics, laboratory findings, and treatment-related variables.

This study identified a substantial burden of CKD-aP among haemodialysis patients, with a prevalence of 46.2%. Among the 49 individuals reporting pruritus, 42.8% experienced disrupted sleep, 19.9% reported reduced social engagement, and 22.4% described the itching as intolerable. Based on severity ratings using the WI-NRS, 42.9% fell within the mild category (scores 1–3), 40.8% were classified as moderate (scores 4–6), and 16.3% experienced severe symptoms (scores 7–10).

Multivariable logistic regression analysis revealed that patients who were not using emollients had statistically significantly lower odds of experiencing pruritus (adjusted OR 0.14; 95% CI: 0.05–0.46; p = 0.001). Although higher serum phosphate levels appeared to be associated with increased CKD-aP risk, this finding did not reach statistical significance (adjusted OR = 2.04; 95% CI: 0.51–8.08; p = 0.311). No significant association was observed between the presence of a dermatological condition and the presence of pruritus (adjusted OR = 1.08; 95% CI: 0.22–5.23; p = 0.928). The use of phosphate binders, calcimimetics, and gabapentin each showed a non-significant trend toward mitigating uremic pruritus.

Chronic kidney disease–associated pruritus (CKD-aP) was observed in 46.2% of haemodialysis patients and was found to significantly disrupt sleep (42.8%), limit social participation (19.9%), and negatively affect overall quality of life. Reported severity ranged from mild (42.9%) and moderate (40.8%) to severe (16.3%). Interestingly, emollient use was associated with a higher likelihood of pruritus, potentially indicating treatment initiated in response to symptom burden. These results underscore the importance of incorporating patient-focused assessments into routine review. Given the current lack of robust therapeutic options, there is a clear need for prospective research to inform more targeted and effective management approaches.