A Longitudinal Study of Uremic Pruritus in Hemodialysis Patients

Overview

Journal Clin J Am Soc Nephrol

Specialty Nephrology

Date 2010 Jun 19

PMID 20558560

Citations 108

Authors

Vandana S Mathur

Jill Lindberg

Michael Germain

Geoffrey Block

James Tumlin

Mark Smith

Mandeep Grewal

Dawn McGuire

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Although uremic pruritus (UP) is a highly prevalent complication of chronic kidney disease, it remains poorly characterized. There have been no longitudinal studies of natural history, and no health-related quality of life (HR-QOL) instruments have been developed for UP. The objectives of this study were to describe the natural history of UP, to compare rating scales of itching intensity, and to assess usefulness and validity of HR-QOL instruments for UP.

Design, Setting, Participants, & Measurements: The intensity, severity, and effects of pathologic itching on HR-QOL were assessed prospectively in 103 patients with UP on chronic hemodialysis. Outcome measures were obtained at scheduled intervals over 3.5 months.

Results: Itching daily or nearly daily was reported by 84% of patients and had been ongoing for >1 year in 59%. In 83%, pruritus involved large, nondermatomal areas with striking bilateral symmetry. Two thirds of the patients were using medications such as antihistamines, steroids, and various emollients without satisfactory relief of itching. Statistically significant associations were found among itching intensity, severity, and HR-QOL measures in domains such as mood, social relations, and sleep. Among patients with moderate-to-severe UP, changes in itching intensity of 20% or greater were associated with significant reductions in HR-QOL measures.

Conclusions: This first longitudinal study of UP describes key features of UP and its effect on HR-QOL. The assessment instruments we have developed are easily used, are responsive to changes in UP intensity, and should facilitate clinical evaluation and research to meet the needs of afflicted patients.

Citing Articles

Successful Use of Difelikefalin in Severe Chronic Kidney Disease-Associated Pruritus in a Patient With Complex Etiological Contributors: A Case Report.

Werzowa J, Hemetsberger M Case Rep Nephrol. 2025; 2025:6626611.

PMID: 40040639 PMC: 11879566. DOI: 10.1155/crin/6626611.

Quality of life and clinical data in hemodialysis patients with different degrees of pruritus.

Fontao S, Manso P, Audije-Gil J, Hernan Gascuena D, Dapena F, Areste N Sci Rep. 2025; 15(1):6222.

PMID: 39979317 PMC: 11842785. DOI: 10.1038/s41598-024-83833-2.

Unveiling the Burden of Pruritus: Its Prevalence and Impact on Sleep Quality in Hemodialysis Patients in Somalia.

Jeele M, Adam A, Addow R Int J Gen Med. 2025; 18:473-482.

PMID: 39901978 PMC: 11789518. DOI: 10.2147/IJGM.S502034.

Chronic Kidney Disease-Associated Pruritus Burden: A Patient Survey Study.

Thompson J, Kammerer J, Boshears T, Oliveira J, Johansen K, Kovar A Kidney Med. 2025; 6(11):100900.

PMID: 39822582 PMC: 11738028. DOI: 10.1016/j.xkme.2024.100900.

Fatigue and Pruritus Impact Sleep Quality in Hemodialysis Patients.

Almutary H Nat Sci Sleep. 2025; 16:2289-2298.

PMID: 39758161 PMC: 11699828. DOI: 10.2147/NSS.S496376.

References

Weisbord S, Fried L, Arnold R, Fine M, Levenson D, Peterson R . Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients. J Am Soc Nephrol. 2005; 16(8):2487-94. DOI: 10.1681/ASN.2005020157. View

McReynolds T, Sheridan B . Intramuscular ketorolac versus osteopathic manipulative treatment in the management of acute neck pain in the emergency department: a randomized clinical trial. J Am Osteopath Assoc. 2005; 105(2):57-68. View

Chen Y, Chiu W, Wu M . Therapeutic effect of topical gamma-linolenic acid on refractory uremic pruritus. Am J Kidney Dis. 2006; 48(1):69-76. DOI: 10.1053/j.ajkd.2006.03.082. View

Ashmore S, Jones C, Newstead C, Daly M, Chrystyn H . Ondansetron therapy for uremic pruritus in hemodialysis patients. Am J Kidney Dis. 2000; 35(5):827-31. DOI: 10.1016/s0272-6386(00)70251-4. View

Yosipovitch G, Zucker I, Boner G, Gafter U, Shapira Y, David M . A questionnaire for the assessment of pruritus: validation in uremic patients. Acta Derm Venereol. 2001; 81(2):108-11. DOI: 10.1080/00015550152384236. View

Pisoni R, Wikstrom B, Elder S, Akizawa T, Asano Y, Keen M . Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2006; 21(12):3495-505. DOI: 10.1093/ndt/gfl461. View

Dar N, Akhter A . Clinical characteristics of uremic pruritus in patients undergoing haemodialysis. J Coll Physicians Surg Pak. 2006; 16(2):94-6. DOI: 2.2006/JCPSP.9496. View

Duque M, Thevarajah S, Chan Y, Tuttle A, Freedman B, Yosipovitch G . Uremic pruritus is associated with higher kt/V and serum calcium concentration. Clin Nephrol. 2006; 66(3):184-91. DOI: 10.5414/cnp66184. View

Zucker I, Yosipovitch G, David M, Gafter U, Boner G . Prevalence and characterization of uremic pruritus in patients undergoing hemodialysis: uremic pruritus is still a major problem for patients with end-stage renal disease. J Am Acad Dermatol. 2003; 49(5):842-6. DOI: 10.1016/s0190-9622(03)02478-2. View

10.

Duque M, Yosipovitch G, Fleischer Jr A, Willard J, Freedman B . Lack of efficacy of tacrolimus ointment 0.1% for treatment of hemodialysis-related pruritus: a randomized, double-blind, vehicle-controlled study. J Am Acad Dermatol. 2005; 52(3 Pt 1):519-21. DOI: 10.1016/j.jaad.2004.08.050. View

11.

Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D . Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2005; 10(4):287-333. DOI: 10.1016/j.ejpain.2005.06.009. View

12.

Ross J, Goller K, Hardy J, Riley J, Broadley K, AHern R . Gabapentin is effective in the treatment of cancer-related neuropathic pain: a prospective, open-label study. J Palliat Med. 2005; 8(6):1118-26. DOI: 10.1089/jpm.2005.8.1118. View

13.

Ikoma A, Rukwied R, Stander S, Steinhoff M, Miyachi Y, Schmelz M . Neurophysiology of pruritus: interaction of itch and pain. Arch Dermatol. 2003; 139(11):1475-8. DOI: 10.1001/archderm.139.11.1475. View

14.

Legroux-Crespel E, Cledes J, Misery L . A comparative study on the effects of naltrexone and loratadine on uremic pruritus. Dermatology. 2004; 208(4):326-30. DOI: 10.1159/000077841. View

15.

Szepietowski J, Szepietowski T, Reich A . Efficacy and tolerance of the cream containing structured physiological lipids with endocannabinoids in the treatment of uremic pruritus: a preliminary study. Acta Dermatovenerol Croat. 2005; 13(2):97-103. View

16.

Watnick S, Wang P, Demadura T, Ganzini L . Validation of 2 depression screening tools in dialysis patients. Am J Kidney Dis. 2005; 46(5):919-24. DOI: 10.1053/j.ajkd.2005.08.006. View

17.

Okada K, Matsumoto K . Effect of skin care with an emollient containing a high water content on mild uremic pruritus. Ther Apher Dial. 2005; 8(5):419-22. DOI: 10.1111/j.1526-0968.2004.00175.x. View

18.

Bennett M, Simpson K . Gabapentin in the treatment of neuropathic pain. Palliat Med. 2004; 18(1):5-11. DOI: 10.1191/0269216304pm845ra. View

19.

Pauli-Magnus C, Mikus G, Alscher D, Kirschner T, Nagel W, Gugeler N . Naltrexone does not relieve uremic pruritus: results of a randomized, double-blind, placebo-controlled crossover study. J Am Soc Nephrol. 2000; 11(3):514-519. DOI: 10.1681/ASN.V113514. View

20.

Manenti L, Vaglio A, Costantino E, Danisi D, Oliva B, Pini S . Gabapentin in the treatment of uremic itch: an index case and a pilot evaluation. J Nephrol. 2005; 18(1):86-91. View