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Between years 2000 and 2007, hospitalizations for MOF continued to increase in Switzerland, driven by an increasing number and incidence of hospitalizations for non-hip fractures, although the incidence of hip fractures has declined.

These results suggest that early detection and disease prevention may be cost effective in the long term. However, additional political measures are necessary to support implementation, as the German SHI is currently lacking the necessary long-term incentives to support preventive screening programmes.

Background Chronic kidney disease associated pruritus (CKD-aP) is a common and burdensome condition for end-stage kidney disease (ESKD) patients, especially those receiving haemodialysis. High quality evidence of the relationship between CKD-aP and health-related quality of life (HRQoL) can therefore inform clinicians and policy makers about treatment choice and reimbursement decisions. Methods Systematic Literature Review and narrative synthesis, stratified by study design and HRQoL instrument was conducted to evaluate the relationship in Adult ESKD patients receiving in-centre haemodialysis between CKD-aP, and HRQoL, assessed using a multi-dimensional, generic or condition-specific, preference- or non-preference-based measures. MEDLINE, EMBASE, Web of Science and BIOSIS Citation indexes, Cochrane Library and PsycINFO from inception to March 2020 were searched with two reviewers extracting data independently. Results Searches identified 2,684 unique records, of which 20 papers relating to 18 unique studies (5 randomised controlled trials and 13 observational studies) were included. HRQoL was assessed using 4 generic and 8 disease-specific measures. The impact of CKD-aP was assessed by comparison of means, linear regression and correlation. Observational studies employing comprehensively adjusted multivariable linear regression largely found associations between CKD-aP severities and HRQoL. Analyses suggest this relationship is partially mediated by the sleep disturbance caused by CKD-aP. RCTs showing improvements in CKD-aP severity were associated with clinically meaningful improvements in HRQoL. Compared to generic measures, disease-specific HRQoL instruments reported greater changes with reduced CKD-aP. Heterogeneity in study design and reporting precluded meta-analysis. Conclusions CKD-aP severity was found to be associated with a worsening of HRQoL in the majority of observational and RCT studies. Parallel improvements in CKD-aP and HRQoL with interventions may support their use. (PROSPERO Registration Number 175035)