Uremic pruritus and associated factors in chronic hemodialysis patients: past and current experience

Abstract

Introduction: Uremic pruritus (UP) is a prevalent but overlooked problem in chronic kidney disease (CKD). This study aimed to investigate the prevalence of UP in chronic dialysis patients and its correlation with demographic, clinical, and biochemical parameters. Methods: The study included all patients >18 years of age who had undergone hemodialysis three days a week for at least six months and agreed to participate. Pregnant women and patients with a history of steroid use, malignancy, chronic liver or biliary tract disease, and dermatological disease were excluded from the study. Pruritus severity was evaluated using the Visual Analog Scale (VAS) and the 5-D Itch Scale. Results: Of 1093 patients, 582 (53.25%) were male, and 511 (46.75%) were female, with a mean age of 62.39±14.27 years. The results showed that 224 (20.5%) patients had UP, with a strong positive correlation between VAS and the 5-D Itch Scale in the pruritus group (r=0.883, p=0.0001). C-reactive protein (CRP) levels were significantly increased, and Kt/V and urea reduction rate (URR) levels significantly decreased in UP patients. In addition, we showed that hypertension, high CRP, and low URR were risk factors affecting UP (p: 0.037, p: 0.048, and p: 0.011, respectively). Grouping patients by pruritus severity as mild, moderate, and severe revealed no significant difference between the groups, except for the significantly lower mean age in the severe pruritus group (p=0.003). Conclusions: The correlation between UP and CRP supported the immune hypothesis in the pathogenesis of UP. Moreover, increasing the dialysis dose may be beneficial in mitigating UP symptoms, even in patients with normal Kt/V and URR levels.