Severe skin itching remains a problem for hemodialysis patients

Pruritus, severe and chronic itching of the skin, is common in people with chronic kidney disease. While mild pruritus may be a nuisance, severe pruritus has a major negative effect on patients’ lives. They are often bothered by the dryness and appearance of their skin and are annoyed by their itching, which has a considerable impact on their social and working lives. Many also suffer restless sleep, which is associated with depression and increased mortality. In a recent paper, investigators studied the prevalence, awareness, and treatment of pruritus to assess how well this important condition is currently managed internationally.

Using data from 17 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS), researchers found that the percentage of patients very much or extremely bothered by itching declined from 28 percent in 1996 to 18 percent in 2015. In 2012-2015, among patients nearly always or always bothered by itching, 18 percent used no treatment for pruritus and 17 percent did not report itching to any health care provider.

The DOPPS data also included survey responses from 268 medical directors in 17 countries in 2012-2015. Investigators found that 69 percent of medical directors underestimated the prevalence of pruritus in their facility. In addition, medical directors ranked phosphorus control and increasing Kt/V as the most important interventions, but no relationship was found between these factors and pruritus.

Although the prevalence of pruritus in people on hemodialysis is decreasing, it remains substantially underestimated. The current model of clinical practice is failing to identify and treat many patients severely affected by itching, and there is a major opportunity to improve patients’ health and wellbeing through increased awareness of pruritus and greater use of effective treatments.

Lead author Dr. Hugh Rayner added, “The take-home message is simple: ask every patient with advanced CKD whether they have itching at every clinical review. You may be surprised by the answers!”