PREVALENCE AND INFLUENCING FACTORS OF CHRONIC KIDNEY DISEASE- ASSOCIATED PRURITUS (CKD-aP) AND ITS IMPACT ON QUALITY OF LIFE AND SLEEP AMONG INDIAN HEMODIALYSIS PATIENTS

 

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https://storage.unitedwebnetwork.com/files/1099/36c1f1391b446429c6cbcf05d3b07748.pdf
PREVALENCE AND INFLUENCING FACTORS OF CHRONIC KIDNEY DISEASE- ASSOCIATED PRURITUS (CKD-aP) AND ITS IMPACT ON QUALITY OF LIFE AND SLEEP AMONG INDIAN HEMODIALYSIS PATIENTS

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Shreya
Jain
Shreya Jain shreyajain.vmmc12@gmail.com Kasturba Medical College, Manipal Department of Nephrology Udupi India *
Mohan VB vbmohan86@gmail.com Kasturba Medical College, Manipal Department of Nephrology Udupi India -
Shankar Prasad nephrology.kmc@manipal.edu Kasturba Medical College, Manipal Department of Nephrology Udupi India -
Dharshan Rangaswamy dharshan.r@manipal.edu Kasturba Medical College, Manipal Department of Nephrology Udupi India -
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Chronic Kidney Disease–associated Pruritus (CKDaP) remains one of the most distressing and underrecognized complications among patients on maintenance hemodialysis. Despite its high prevalence and significant effect on sleep and overall well-being, regional data from low and middle-income countries, including India, remain limited. This study aimed to determine the prevalence, severity, and influencing factors of CKDaP and to evaluate its impact on quality of life and sleep using validated assessment tools.

Patient demographics, dialysis parameters (vintage, frequency, and adequacy measured by Kt/V), and relevant biochemical variables were extracted from the hospital’s electronic medical records (EMR). The 12-Item Pruritus Severity Scale and the 5D Itch Scale were employed to assess pruritus severity and multidimensional burden. Quality of life was evaluated using the Dermatology Life Quality Index (DLQI) and Skindex-16, while sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Statistical analyses were performed using SPSS version 21 to examine correlations between pruritus severity, dialysis parameters, and laboratory profiles, with significance set at p<0.05.

Pruritus severity according to 12-Item Pruritus Severity Scale

Distribution of Pruritus According to 5D Itch Scale

Among 216 hemodialysis patients, the prevalence of CKDaP was 60.6%, with mild, moderate, and severe pruritus observed in 37.0%, 19.9%, and 3.7% of participants, respectively. Most affected patients were male and aged 50–79 years, with diabetic kidney disease as the leading CKD etiology. Dialysis adequacy, frequency, and duration showed no significant differences between pruritic and non-pruritic groups. Laboratory variables, including hemoglobin, albumin, calcium, phosphorus, and parathyroid hormone levels, were also not significantly associated with pruritus. The 5D Itch Scale showed that 52.9% of patients with moderate-to-severe pruritus experienced prolonged daily itching, most commonly over the back (77.9%), with no significant change over time (p=0.18). Quality-of-life assessment revealed a substantial burden: 75.5% reported impairment on the Dermatology Life Quality Index (DLQI), and Skindex-16 indicated marked emotional and functional distress among those with higher pruritus severity. Sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), worsened significantly with increasing pruritus intensity (p<0.01).

CKDaP is highly prevalent among Indian hemodialysis patients, significantly affecting quality of life and sleep, even in the absence of clear biochemical predictors. These findings highlight the need for routine screening and targeted management strategies in dialysis centers, particularly in resource-constrained settings. By documenting region-specific patterns and burdens, this study contributes valuable data to the global understanding of CKDaP and supports the prioritization of symptom-based interventions in chronic kidney disease care.

Kewords