Chronic kidney disease-associated pruritus significantly impacts on quality of life of patients on haemodialysis and associates with increased levels of serum calcium and phosphorus

Symptom profiles in patients receiving maintenance hemodialysis and their association with quality of life: a longitudinal study

PURPOSE

Many patients receiving maintenance hemodialysis experience one or multiple symptoms. Using a latent profile analysis to identify symptom profiles may provide insights for person-centered symptom management strategies.

METHODS

This is a longitudinal study based on data from patients receiving maintenance hemodialysis at three hospitals in Shanghai, China. Of the 448 patients who completed the surveys at baseline (T1), 309 completed the 12-month follow-up survey (T2). Symptoms and quality of life were measured by the Chinese version of Kidney Disease Quality of Life 36 Short Form. The optimal classification of symptoms was identified using latent profile analysis.

RESULTS

Five symptom profiles were identified: High (9.2%), Fatigue and Gastrointestinal (7.1%), Fatigue and Skin (10.7%), Skin (23.2%), and Low (49.8%). The high-symptom profile and the-fatigue-and-skin-symptom profile were associated with a lower level of physical functioning, a higher burden of kidney disease, and more negative effects of kidney disease than the low symptom profile at T1 and T2. Multivariate regression analysis showed that the high-symptom profile predicted a poorer physical functioning at T2, and the-fatigue-and-skin-symptom profile predicted a poorer physical functioning and higher burden of kidney disease at T2.

CONCLUSION

Patients receiving maintenance hemodialysis reported unique symptom experiences which could be classified into different profiles. Patients reporting an overall high level of symptoms or a high level of fatigue and skin symptoms were more likely to have a poorer quality of life.

Clinical Efficacy and Safety of Chinese Herbal Medicine in the Treatment of Uremic Pruritus: A Meta-Analysis of Randomized Controlled Trials

Uremic pruritus is a disturbing and refractory symptom in patients with advanced chronic kidney disease. Chinese herbal medicine has been reported to alleviate uremic pruritus. To investigate the effects of Chinese herbal medicine, we conducted a systematic review and meta-analysis on patients with uremic pruritus. We searched databases (prior to 3 May 2022) for randomized controlled trials on the effects of Chinese herbal medicine in treating uremic pruritus. Our meta-analysis included 3311 patients from 50 randomized controlled trials. In patients with uremic pruritus, adjunctive Chinese herbal medicine significantly improved overall effectiveness (risk ratio 1.29, 95% CI 1.23 to 1.35), quality of life, renal function, reduced pruritus score, and inflammatory biomarkers compared to control groups with hemodialysis alone or with anti-pruritic treatments. Chinese herbal medicine treatment showed a time-dependent tendency in improving the visual analog scale of dialysis patients. Compared to control groups, no significantly higher risk of adverse events in patients taking Chinese herbal medicine (risk ratio 0.60, 95% CI 0.22 to 1.63). Chinese herbal medicine appears to be effective and safe in complementing the treatment of patients with uremic pruritus.

Prevalence of pruritus associated with hemodialysis and its association with sleep quality among hemodialysis patients: a multicenter study

BACKGROUND

CKD-associated pruritus (chronic kidney disease-associated pruritus) is one of the common symptoms in hemodialysis patients, with a major effect on sleep quality because it occurs at night. The main objective of this study is to determine the prevalence of pruritus among hemodialysis (HD) patients and its impact on sleep and investigate factors associated with pruritus and sleep quality.

METHODS

A cross-sectional study began in January until March of 2021 in HD centers of four different hospitals in the West Bank, Palestine. Patients with HD aged 18 years or older were included in our investigation. Pruritus and sleep problems were assessed by a 5-D itching score and the Pittsburgh Sleep Quality Index (PSQI) score.

RESULTS

Of 280 HD patients, 250 were accepted to participate in our study. The mean age of the participants was (54.9 ± 15.08). 62.8% were male, and 42.4% of the participants were elderly (age ≥ 60yrs). Pruritus was observed in 121 (48.4%). The 5-D itching score had a median [IQR] of 5.0[5.0-15.0], and 57.2% had a score ≥ 6 points. Severe pruritus was reported in 28.1% of patients. The score was significantly associated with residency (p = 0.033) and chronic comorbidities (p = 0.026). The PSQI score has a median [IQR] of 8[5-12], and 66.4% are poor sleepers with a score of < 5. The score was significantly associated with age (p = 0.017), marital status (p = 0.022), occupational status (p = 0.007), chronic comorbidities (p > 0.001), chronic medication (p = 0.008), severity of pruritus (p = 0.003) and duration of pruritus (p = 0.003). Regression analysis showed that the 5-D itching score and the total number of comorbidities were significantly associated with the PSQI score.

CONCLUSIONS

Pruritus is a widespread complication among HD patients in Palestine. Pruritus also has major effects on sleep quality and is associated with poor sleep quality.