Chronic kidney disease-associated pruritus: a comparison of instruments and associations with patient-reported outcomes using an electronic patient-reported outcome survey in Europe

Murilo Guedes; Charlotte Tu; Nidhi Sukul; Elham Asgari; Fitsum Guebre-Egziabher; Despina Ruessmann; Thilo Schaufler; Hugh Rayner; Michel Jadoul; Laura Labriola; Roberto Pecoits-Filho; Ronald L Pisoni; Angelo Karaboyas

doi:10.1093/ckj/sfae276

Chronic kidney disease-associated pruritus: a comparison of instruments and associations with patient-reported outcomes using an electronic patient-reported outcome survey in Europe

Clin Kidney J. 2024 Sep 4;17(10):sfae276. doi: 10.1093/ckj/sfae276. eCollection 2024 Oct.

Authors

Affiliations

¹ Arbor Research Collaborative for Health, Ann Arbor, USA.
² Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
³ Division of Nephrology, Veterans Affairs Ann Arbor Health System, Ann Arbor, USA.
⁴ Department of Nephrology, Guy's, St Thomas Hospital, London, UK.
⁵ Service de Nephrologie, Hopital Edouard Herriot, Hospices Civils de Lyon, INSERM U1060 université Lyon-1, Lyon, France.
⁶ CSL-Vifor, Glattbrugg, Switzerland.
⁷ Birmingham Heartlands Hospital, Birmingham, UK.
⁸ Department of Nephrology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.

Abstract

Background: The associations between self-reported chronic kidney disease-associated pruritus (CKD-aP) and patient-reported outcomes (PROs) have been reported using various instruments to assess itch. Data collection via multiple CKD-aP instruments allows the evaluation of different domains and measurements of CKD-aP burden and may help tailor data capture for future research or clinical care.

Methods: An electronic PRO (ePRO) survey was distributed to European hemodialysis (HD) patients enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) in 2021-23. The DOPPS is an international cohort study that aims to investigate practice patterns and outcomes in HD patients. The ePRO survey included multiple CKD-aP instruments: Average Itch and Worst Itching Intensity Numerical Rating Scales (AI-NRS, WI-NRS) and a Kidney Disease Quality of Life (KDQOL)-36 single question. Linear and logistic regression were used to estimate adjusted associations between CKD-aP instruments and various PROs.

Results: This analysis included 769 patients who completed the WI-NRS from HD facilities in France, Germany, Italy, Spain, Sweden and the UK. The correlation between WI-NRS and the KDQOL-36 itch question was 0.88 overall and 0.46 among patients at least somewhat bothered by itch. Mean WI-NRS scores stratified by response to the KDQOL-36 itch question were 8.1, 6.4, 4.1 and 3.1 for extremely, very much, moderately and somewhat bothered, respectively. Patients with worse WI-NRS scores reported worse sleep quality, greater fatigue, more depressive symptoms, and lower mental and physical quality of life; these associations were similar to those observed for the KDQOL-36 itch question.

Conclusion: Correlation between CKD-aP instruments was high overall, but moderate among the subgroup of patients bothered by itch; differences can be partially attributed to the recall period for the KDQOL-36 (4 weeks) vs the AI- and WI-NRS (24 h). The consistent associations of these instruments with poor outcomes underscores the importance to identify and effectively treat HD patients suffering from pruritus.

Keywords: hemodialysis; patient-reported outcomes; pruritus.