Hemodialysis

Uremic pruritus frequently underrecognized in modern dialysis era

Lea Merritt

April 21, 2006

April 21, 2006


Chicago, IL - Persistent uremic pruritus is frequently underrecognized in the modern dialysis era, according to a national survey presented here [ 1 , 2 , 3 ].

Nephrologists also tend to underestimate the severity of the condition in their dialysis patients, as well as its impact on quality of life.

"We found that nephrologists feel this problem is mild to moderate, whereas patients feel it's a moderate to severe problem," Dr Sarbani Bhaduri (Acologix, Hayward, CA) told renal wire in an interview. "Even if nephrologists do recognize it as a problem, they don't have good therapies to treat it, so they need new treatments."

Findings from the web-based, interactive survey were presented here during the National Kidney Foundation 2006 Spring Clinical Meeting.


Independent third party

As presented by lead author Vandana Mathur (Mathur Consulting, Woodside, CA), the survey (developed by an independent third party) was given to hemodialysis patients experiencing at least intermittent pruritus. Of 225 patients who were initially screened, 101 patients met the inclusion criteria of having been on hemodialysis for at least six months and receiving hemodialysis two to four times a week. Mean age of the respondents was 36 years?"younger than that of the typical dialysis population, which may in part reflect familiarity of younger patients with internet and web-based surveys," investigators note.

Participants were questioned on a number of aspects related to their pruritus, including severity, frequency, location, and effect on mood and sleep. The visual analog scale (VAS) which has been validated as an instrument to assess itch?used a scale from 0 (no itch) to 100 (worst imaginable itch).

Respondents rated the severity of their itching in the past seven days at 63 on the VAS scale?despite the fact that the majority of respondents were taking antihistamines to relieve the itch. The mean duration of itching was seven days.

Some two thirds of respondents also indicated that they were "very much" or "extremely bothered" by their pruritus, while 25% indicated that they were "moderately bothered" by the itching. Itching also made patients extremely self-conscious, and almost 80% of respondents indicated that their symptoms inhibited social interaction.

The survey also assessed the number of nights per week in which itching affected sleep. "In over 40% of subjects, pruritus affected the ability to sleep on greater than three nights per week," investigators report, "and pruritus also reduced the number of hours of sleep, from 6.9 hours of expected sleep time to 4.6 hours." Earlier studies have shown that sleep deprivation is associated with a higher mortality rate.

Thus, if pruritus is not adequately treated, hemodialysis patients may be at risk for prolonged sleep deprivation: indeed, lack of sleep may well be a key variable linking uremic pruritus and a higher mortality risk, the authors note.


Less bothersome

The same survey also suggested that nephrologists feel uremic pruritus is much less bothersome to patients than patients themselves experience. For example, 95% of patients described their symptoms as "moderate to severe," whereas 70% of nephrologists categorized symptoms as "mild to moderate." "Furthermore," investigators indicate, "the most important drugs to patients were those that helped with bothersome symptoms, whereas those considered important by nephrologists corrected laboratory abnormalities."

Nephrologists also felt that only about 39% of their hemodialysis patients had any degree of pruritus. They also indicated that any failure to control it was largely due to the inadequacy of current therapies.

"Uremic pruritus should not be thought of as 'just itch' but should be considered as a serious debilitating condition that further affects an already compromised quality of life in patients with renal failure," investigators conclude. "Underrecognition of pruritus may adversely affect patient outcomes."


The survey was funded by Acologix.


Sources

  1. Mathur V, Bhaduri S, Fellmann J. Differences in perception of uremic pruritus between hemodialysis patients and nephrologists. National Kidney Foundation 2006 Spring Clinical Meeting; April 19-23, 2006; Chicago, IL. Abstract 81.

  2. Mathur V, Fellmann J, Bhaduri S, et al. Under-recognized persistence of uremic pruritus in the modern dialysis era: A national survey. National Kidney Foundation 2006 Spring Clinical Meeting; April 19-23, 2006; Chicago, IL. Abstract 82.

  3. Mathur V, Bhaduri S, Fellmann J, A survey of the treatment and perception of uremic pruritus by United States nephrologists. National Kidney Foundation 2006 Spring Clinical Meeting; April 19-23, 2006; Chicago, IL. Abstract 80.


 

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