A longitudinal study of uremic pruritus in hemodialysis patients.
OBJECTIVE
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.


METHODS
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.
Mathur
Vandana S
VS
Acologix, Inc., Hayward, California 94545, USA.
Lindberg
Jill
J
Germain
Michael
M
Block
Geoffrey
G
Tumlin
James
J
Smith
Mark
M
Grewal
Mandeep
M
McGuire
Dawn
D
D000328:Adult; D000982:Antipruritics / Q000627:therapeutic use; D016009:Chi-Square Distribution; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011537:Pruritus / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology; D011788:Quality of Life; D012042:Registries; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014511:Uremia / Q000209:etiology* / Q000523:psychology / Q000628:therapy
D000982:Antipruritics