Longitudinal Trajectories of CKD-Associated Pruritus

Chronic kidney disease (CKD)-associated pruritus (CKD-aP) is a common and distressing symptom among dialysis patients, negatively affecting patient-reported outcomes (PROs) such as sleep and mental health. Despite its high prevalence, the evolution, incidence, and long-term impact of CKD-aP remains poorly understood. This study examined the cumulative incidence of new-onset CKD-aP among patients on hemodialysis (HD), identified its key predictors, and assessed associations between CKD-aP severity and PROs.

In this prospective, multicenter cohort study, incident and prevalent HD patients from 6 European countries were followed over 18 months, with assessments every 3 months. Patients completed an electronic PRO (ePRO) survey, including the Kidney Disease Quality of Life Short Form 36-Item short-form survey itchy skin item and measures of fatigue, sleep, depression, and general health. Sankey diagrams and Spearman's correlations were used to describe pruritus evolution. Cox and linear regression models were used to identify predictors of moderate-to-severe pruritus and examined associations with PROs.

Among 747 patients, the 18-month cumulative incidence of moderate-to-severe pruritus was 52%. Baseline-to-follow-up correlations for pruritus severity declined over time, though short-term correlations remained strong. Sociodemographic and clinical characteristics were minimally predictive of incident pruritus. Compared with those without pruritus, patients with incident pruritus reported higher fatigue (+0.7 [0.1-1.4]) and lower sleep quality scores (-1.0 [-1.6 to -0.5]). Similar patterns were observed for persistent versus resolved pruritus.

CKD-aP is a prevalent and fluctuating symptom in patients on HD. Its association with poorer fatigue and sleep outcomes highlights the importance of ongoing monitoring and targeted management to improve patient well-being.