Patient Reported Burden of Pruritus Associated with CKD

Pruritus is an extremely uncomfortable condition with negative impacts on patient quality of life. Patients with chronic kidney disease (CKD) stages 4 and 5 are at increased risk for CKD-associated pruritus (CKD-aP). Gail Torres, RN, MS, RD, and Linda Singleton-Driscoll conducted a study to examine the impact of pruritus in patients with CKD stages 2, 3, 4, and 5 not on dialysis (5ND). Results of the study were reported during a poster session at the NKF SCM22 in a poster titled Burden of Pruritus in Patients with Chronic Kidney Disease: A National Kidney Foundation Patient Survey.

In studies evaluating electrolyte abnormalities in patients following solid organ transplant, a significant number of patients are described as developing hyperkalemia. Hyperkalemia after solid organ transplant has been attributed to the use of certain prophylactic antibiotics such as trimethoprim-sulfamethoxazole, as well as antirejection medications, particularly calcineurin inhibitors.

The study utilized an online survey of adults ≥18 years of age across the United States. Using links on the National Kidney Foundation Facebook, Twitter, and LinkedIn pages, the survey was conducted from June 16-22, 2021. The first 300 respondents with a valid email address received a $5 gift card. Patients who identified as being in CKD stages 4 and 5 ND were oversampled to ensure a sufficient number for analysis.

Of the 1870 initial respondents, 473 had incomplete surveys, 114 did not have CKD, 224 had an earlier stage of CKD, and 122 were receiving dialysis, resulting in a study cohort of 937 participants.  Mean age was 31.4 years, 50% were female, 93% were employed or in school, 76% were non-Hispanic White, 24% were Black or African American, 5% were Hispanic, 4% were American Indian, and 3% were Asian.

Pruritus was common. Among patients with CKD stage 2, 58% (n=88/152) reported recurring itch at least somewhat intense on a Likert scale. In stages 3, 4, and 5, the proportion of patients reporting itch at least somewhat intense increased slightly to 61% to 62% (stage 3, n=69/113; stage 4, n=161/238; and stage 5, n=252/414). The severity of the itch increased in later stages: 57% in stage 4 (n=146/258) and 34% in stage 5 (n=142/414) rating their worst itch in the past 24 hours as ≥7 out of 10 compared with 10% in stage 2 (n=11/113) and 14% in stage 2 (n=22/152).

Patients with later stages of CKD also reported increased effects of pruritus: 44% (n=67/152) of patients with CKD stage 2 reported that itch affected them at least somewhat on a Likert scale. The proportion rose to 81% in stage 4 (n=208/258) and 62% in stage 5 (n=257/414). The proportion of patients reporting that itch interfered with daily activities also increased, from 22% in stages 2 and 3 (34/152; 25/113) to 50% in stage 4 (n=130/258) and 36% in stage 5 (n=149/414).

In summary, the researchers said, “This survey showed that pruritus is fairly widespread, even in earlier CKD. However, patients in CKD stages 4-5ND reported itch that is more severe in intensity, and with a greater burden on their daily activities compared with patients in earlier stages. These results suggest that the impact of pruritus on quality of life may worsen as CKD becomes more advanced.”

Source: Torres G, Singleton-Driscoll L. Burden of pruritus in patients with chronic kidney disease: A National Kidney Foundation Patient Survey. Abstract of a poster (Poster #259) presented at the National Kidney Foundation 2022 Spring Clinical Meetings, Boston, Massachusetts, April 6-10, 2022.