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Impact
CKD-aP may impact many aspects of patients’ lives1,2

CKD-aP is an important concern for affected patients, as it may impact their quality of life and disturb their sleep, and they are more likely to suffer with depression, compared with patients not bothered by itching.1,2

Hear from an expert

In this video, Dr. Rastogi talks about the physical and mental impacts
of CKD-aP on hemodialysis patients’ lives.

This is an actual treating physician who was compensated for his time and consents to this use. Nothing in this video or website constitutes medical advice or treatment guidance.

More information about the expert

Anjay Rastogi, MD, PhD

Nephrologist, Los Angeles, CA
Member, ASN, NKF, ISN

Reduced physical and mental health-related quality of life:
Depression
a
  • Patients who reported they are bothered by CKD-aP are more likely to experience depression1
  • 44% of patients in DOPPS* reported depressive symptoms1
Poor sleep quality
a
  • Patients with severe CKD-aP are 2–2.5 times more likely to report poor sleep quality than patients who report not being disturbed by itching1
  • 32% of patients in DOPPS* reported poor sleep quality1
Social isolation
a
  • CKD-aP may impact patients in their social interactions due to the appearance of their skin and the need to scratch, which causes frustration and embarrassment, contributing to social isolation2,5

CKD-aP=chronic kidney disease–associated pruritus; DOPPS=Dialysis Outcomes and Practice Patterns Study; HD=hemodialysis.

*Phases 4–6 of DOPPS (a prospective cohort study) included 34,694 HD patients in 21 countries from 2009–2018; 23,264 patients were eligible for analysis of the primary outcome.

In hemodialysis patients, CKD-aP may put a burden on
healthcare resources1,3
a

Patients in DOPPS* with very severe CKD-aP† had a ~20% greater
risk of all-cause, cardiovascular-related, and infection-related hospitalization1‡

Patients with severe CKD-aP had an increased risk§ of other serious comorbidities, including3:

а
Bacteremia
a
Septicemia
a
Cardiovascular
disease
a
COPD
a
Liver
disease

CKD-aP=chronic kidney disease–associated pruritus; DOPPS=Dialysis Outcomes and Practice Patterns Study; COPD=chronic obstructive pulmonary disease; HD=hemodialysis.

*Phases 4–6 of DOPPS (a prospective cohort study) included 34,694 HD patients in 21 countries from 2009–2018; 23,264 patients were eligible for analysis of the primary outcome.

†Defined as patients who reported being extremely bothered by itch.

‡Versus those who reported not being bothered by itch at all.

§Versus those less bothered by itch.

In hemodialysis patients, CKD-aP is associated with an increased risk of mortality1
While additional studies are needed, an association between CKD-aP and mortality has been observed:
a

In DOPPS,* patients with very severe CKD-aP† had a 24% higher risk of death within the 18-month follow-up period than those not bothered by itching1

When compared to patients not bothered by itching, patients with very severe CKD-aP were1:

a

more likely to die from
cardiovascular events

a

more likely to die
from infection

Talk to your CKD patients undergoing hemodialysis

Ask if they’ve experienced sleep disruption, social isolation, or depression
due to pruritus at their next appointment or dialysis session.

CKD-aP=chronic kidney disease–associated pruritus; DOPPS=Dialysis Outcomes and Practice Patterns Study; HD=hemodialysis.

*Phases 4–6 of DOPPS (a prospective cohort study) included 34,694 HD patients in 21 countries from 2009–2018; 23,264 patients were eligible for analysis of the primary outcome.

†Defined as patients who reported being extremely bothered by itch.

A multifactorial pathophysiology

Research suggests that the pathophysiology of CKD-aP is multifactorial and may be caused by opioid dysregulation, immune system dysfunction, toxin deposition, and/or peripheral neuropathy.4

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References
References
  1. Sukul N, Karaboyas A, Csomor PA, et al. Self-reported pruritus and clinical, dialysis-related, and patient-reported outcomes in hemodialysis patients. Kidney Med. 2020;3(1):42–53. doi:10.1016/j.xkme.2020.08.011
  2. Rayner HC, Larkina M, Wang M, et al. International comparisons of prevalence, awareness, and treatment of pruritus in people on hemodialysis. Clin J Am Soc Nephrol. 2017;12(12):2000–2007. doi:10.2215/CJN.03280317
  3. Ramakrishnan K, Bond CT, Claxton A, et al. Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms. Int J Nephrol Renovasc Dis. 2014;7:1–12. doi:10.2147/IJNRD.S52985
  4. Verduzco HA, Shirazian S. CKD-associated pruritus: new insights into diagnosis, pathogenesis, and management. Kidney Int Rep. 2020;5(9):1387–1402. doi:10.1016/j.ekir.2020.04.027
  5. Silverberg JI, Kantor RW, Dalal P, et al. A comprehensive conceptual model of the experience of chronic itch in adults. Am J Clin Dermatol. 2018;19(5):759-769. doi:10.1007/s40257-018-0381-6