Severity of Pruritus and Adverse Outcomes

Patients with advanced chronic kidney disease (CKD) commonly experience pruritus. Pruritus is associated with depression, decreased quality of life, and poor sleep quality. There are few data available on clinical outcomes associated with pruritus in patients with CKD not on dialysis.

Angelo Karaboyas, PhD, and colleagues conducted an analysis of data from CKDopps (Chronic Kidney Disease Outcomes and Practice Patterns Study), a nephrology clinic-based cohort study of patients with estimated glomerular filtration rate <60 mL/min/1.73 m². Results of the analysis were reported during a poster session at NKF SCM22 in a poster titled Uremic Pruritus and Clinical Outcomes in Non-Dialysis CKD.

The analysis included data from 498 patients in Brazil and 1210 patients in the United States (total=1708) in 2013-2020. Patients self-reported the extent to which they were bothered by itch over the past 4 weeks. After adjustments for confounders, the association between severity of pruritus and time-to-event outcomes was examined using Cox regression.

More than half of the patients (53%) reported being at least somewhat bothered by itch. Of the patients reporting being at least moderately bothered by itch, 21% were taking an antihistamine, 11% were taking a gabapentin, and 0.6% were taking a pregabalin; 72% were not prescribed any of the medications commonly prescribed for itch.

Over a median follow-up of 1.2 years, there were associations between pruritus severity and higher incidence of progression to initiation of kidney replacement therapy (P for trend <.001), all-cause mortality (P for trend =0.12), and all-cause hospitalization (P for trend =.17).

In summary, the authors said, “The majority of CKD patients reported some level of pruritus, and these patients were largely untreated. Pruritus severity was associated with higher incidence of KRT, mortality and hospitalization. Further research is needed to evaluate the potential impact of pruritus treatment on these clinical outcomes.”

Source: Karaboyas A, Tu C, Speyer E, et al. Uremic pruritus and clinical outcomes in non-dialysis CKD. Abstract of a poster (Poster #221) presented at the National Kidney Foundation 2022 Spring Clinical Meetings, Boston, Massachusetts, April 6-10, 2022.