Chronic kidney disease associated pruritus and healthcare resource utilization in European hemodialysis patients: results from an electronic patient-reported outcome survey

Background Chronic kidney disease-associated pruritus (CKD-aP) is highly prevalent among hemodialysis (HD) patients, yet frequently underreported and underdiagnosed. While CKD-aP is associated with adverse patient-reported and clinical outcomes, the relationship between incident, persistent, and resolving CKD-aP rather than only severity and healthcare resource utilization (HCRU) has not been well explored.

Methods We analyzed 2,631 electronic patient-reported outcome (ePRO) surveys from 747 HD patients in six European countries participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 7 (2021–2023). Patients completed surveys every three months for up to 18 months. Logistic regression estimated associations of pruritus severity and evolution with outcomes including self-reported pruritus treatment, non-nephrologist physician visits, and a composite of hospitalization and emergency room (ER) visit within three months.

Results Within three months of pruritus assessment, patients moderately bothered by pruritus had ER visit, hospitalization, and skin infection rates of 4%, 12%, and 11%, respectively; those very much or extremely bothered had rates of 10%, 15%, and 6%, compared to 5%, 8%, and 4% in patients not at all bothered. Patients developing incident pruritus over three months were more likely to report a skin infection than those without pruritus (OR = 2.34, 95% CI: 1.11, 4.90). Patients very much or extremely bothered were most likely to visit a dermatologist (13%), especially those persistently bothered three months later. Use of over-the-counter oral medications (e.g., antihistamines) was highest among patients very much or extremely bothered (21%) and those persistently bothered.

Conclusion Despite high symptom burden, most patients with bothersome CKD-aP remained untreated. High prevalences of ER visits, hospitalization, and skin infection among patients bothered by itch in cross-sectional and longitudinal analyses suggest identifying incident and persistent CKD-aP may be as important as quantifying severity, arguing for serial measurement and intervention at lower severity to prevent downstream HCRU.