title: Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).
abstract: BACKGROUND
  Pruritus affects many haemodialysis (HD) patients. In this study, pruritus and its relationship to morbidity, mortality, quality of life (QoL), sleep quality and patient laboratory measures were analysed in >300 dialysis units in 12 countries.
  
  
  METHODS
  Pruritus data were collected from 18 801 HD patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) (1996-2004). Analyses were adjusted for age, gender, black race, Kt/V, haemoglobin, serum albumin, albumin-corrected serum calcium, serum phosphorus, 13 comorbidities, depression, years on dialysis, country and facility clustering effects.
  
  
  RESULTS
  Moderate to extreme pruritus was experienced by 42% of prevalent HD patients in DOPPS during 2002/2003. Many patient characteristics were significantly associated with pruritus, but this did not explain the large differences in pruritus between countries (ranging from 36% in France to 50% in the UK) and between facilities (5-75%). Pruritus was slightly less common in patients starting HD than in patients on dialysis >3 months. Pruritus in new end-stage renal disease (ESRD) patients likely results from pre-existing conditions and not haemodialysis per se, indicating the need to understand development of pruritus before ESRD. Patients with moderate to extreme pruritus were more likely to feel drained [adjusted odds ratio (AOR) = 2.3-5.2, P < 0.0001] and to have poor sleep quality (AOR = 1.9-4.1, P < or = 0.0002), physician-diagnosed depression (AOR = 1.3-1.7, P < or = 0.004), and QoL mental and physical composite scores 3.1-8.6 points lower (P < 0.0001) than patients with no/mild pruritus. Pruritus in HD patients was associated with a 17% higher mortality risk (P < 0.0001), which was no longer significant after adjusting for sleep quality measures.
  
  
  CONCLUSIONS
  The pruritus/mortality relationship may be substantially attributed to poor sleep quality. The many poor outcomes associated with pruritus underscore the need for better therapeutic agents to provide relief for the 40-50% of HD patients affected by pruritus.
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, MI, USA. ronald.pisoni@arborresearch.org
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.forename: Björn
authors.initials: B
authors.lastname: Wikström
authors.forename: Stacey J
authors.initials: SJ
authors.lastname: Elder
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.forename: Yashushi
authors.initials: Y
authors.lastname: Asano
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Keen
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
authors.forename: David C
authors.initials: DC
authors.lastname: Mendelssohn
authors.forename: Eric W
authors.initials: EW
authors.lastname: Young
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011537:Pruritus / Q000453:epidemiology / Q000209:etiology*; D006435:Renal Dialysis / Q000009:adverse effects*