Chronic kidney disease-associated pruritus (CKD-aP) is associated with worse quality of life and increased healthcare utilization among dialysis patients

Titapiccolo, Jasmine Ion; Lonati, Caterina; Goethel-Paal, Berit; Bello, Abraham Rincon; Bellocchio, Francesco; Pizzo, Alessandro; Theodose, Maxime; Salvador, Maria Eva Baró; Schofield, Michaela; Cioffi, Mario; Basnayake, Kolitha; Chisholm, Caitlin; Mitrovic, Stéphane; Trkulja, Marjelka; Arens, Hans-Juergen; Stuard, Stefano; Neri, Luca

doi:10.1007/s11136-023-03438-6

Cited by 7 publications

(5 citation statements)

References 45 publications

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“…Chronic Kidney Disease-associated Pruritus (CKD-aP) represent a signi cant burden for patients undergoing hemodialysis. In a recent, European, multicenter, cross-country study of CKD-aP, almost half of patients reported mild to severe pruritus [1], a prevalence consistent with a meta-analysis collating surveys published until year 2016 [2]. In that study, we also observed increased utilization of antidepressant medications, antihistamines and systemic gabapentinoids among patients with severe CKD-aP during the year preceding the survey.…”

Section: Introductionsupporting

confidence: 86%

“…The clinical setting and patients' engagement procedures have been previously described in detail [1]. Brie y, beginning from September 2021 all clinics belonging to the FMC Nephrocare network in France, Ireland, Italy, Spain and UK, introduced a quality improvement program addressing quality of life issues experienced by patients on dialysis (ePROM-CQI).…”

Section: Methodsmentioning

confidence: 99%

“…Pruritus was classi ed in 5 severity classes (not present to very severe) combining responses to the 5-D Itch and KDQOL-36 questionnaires as described in Titapiccolo et al [1]. Prescription of systemic pruritus medications, gabapentin or pregabalin, and antidepressants 3, 6 and 12 months after survey administration, was assessed by ATC codes.…”

Section: Methodsmentioning

confidence: 99%

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CKD-Associated Pruritus is associated with greater use of antidepressants and anti-pruritus medications

Titapiccolo,

Neri,

Schaufler

et al. 2023

Preprint

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Chronic kidney disease–associated pruritus (CKD-aP) is a common, yet underdiagnosed condition among patients on hemodialysis. Considering the lack of established treatment pathways, we sought to evaluate the use of antidepressant, systemic antihistamines or gabapentinoid medications among patients with CKD-aP in the year following pruritus assessment. We included 6209 hemodialysis patients in the analysis. We retrospectivelly extracted clinical and patient-reported data from electronic health records. The intensity of CKD-aP was assessed by KDQOL-36 and 5-D Itch questionnaires. Prescription of antidepressant, antihistamine, and gabapentinoids was ascertained by the occurrence of a suggestive active medical order in patients’ medical records. We observed a consistent and graded association between the severity of CKD-aP and the use of antidepressant, systemic antihistamines and gabapentinoid medications. This association remained consistent and intensified over the duration of the year after pruritus screening. This trend was robust even after accounting for potential confounding factors. Even though we cannot exclude the possibility that these drugs have been prescribed to treat medical conditions warranting their use, previous evidence suggested that doctors may also use such medications in the attempt to buffer CKD-aP. These findings underline the importance of further elucidating current treatment strategies adopted in clinical practice to address CKD-aP.

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Section: Introductionsupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

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CKD-Associated Pruritus is associated with greater use of antidepressants and anti-pruritus medications

Titapiccolo,

Neri,

Schaufler

et al. 2023

Preprint

Self Cite

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“…From the current systematic review, acupuncture therapy may help symptom management and improve CKD patients’ quality of life. Pruritus is one of the symptoms with high incidence and frequency in CKD, especially end-stage renal disease, which interferes with sleep, reduces the quality of life, and causes severe distress to patients [ 63 , 64 ]. Since uremic pruritus is closely related to kidney function [ 65 ], acupuncture treatment improves kidney function and reduces pruritus to some extent.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic effects of acupuncture therapy for kidney function and common symptoms in patients with chronic kidney disease: a systematic review and meta-analysis

Liu,

Zhang,

Bai

et al. 2024

Renal Failure

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Purpose: The number of clinical reports of acupuncture therapy in chronic kidney disease (CKD) is gradually increasing. This systematic review and meta-analysis aim to examine the therapeutic role of acupuncture therapy in kidney function and common symptoms in CKD patients. Methods: We searched Embase, PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, WanFang, and WeiPu for randomized controlled trials comparing acupuncture treatment with control or placebo groups. We assessed the effect of acupuncture therapy in CKD patients using a meta-analysis with the hartung-knapp-sidik-jonkman random effects model. In addition, we visualized keyword co-occurrence overlay visualization with the help of VOSviewer software to describe the research hotspots of acupuncture therapy and CKD. Results: A total of 24 studies involving 1494 participants were included. Compared to the control group, acupuncture therapy reduced serum creatinine levels (standardized mean difference [SMD]: −0.57; 95% CI −1.05 to −0.09) and relieved pruritus (SMD: −2.20; 95% CI −3.84, −0.57) in patients with CKD, while the TSA showed that the included sample size did not exceed the required information size. The included studies did not report acupuncture-related adverse events. Conclusions: Acupuncture is an effective and safe treatment for improving kidney function and relieving pruritic symptoms in patients with CKD, but the very low evidence may limit this conclusion. The TSA suggests that high-quality trials are needed to validate the efficacy of acupuncture therapy.

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“…It is noteworthy that the prevalence of UP is particularly high in Asian regions, especially in China, Japan, and Pakistan, while it is the lowest in Germany ( Zhang et al, 2023 ). UP affects the quality of life of patients with ESRD, leading to sleep disturbances, depression, and anxiety ( Sukul et al, 2021 ; Titapiccolo et al, 2023 ). Given the high prevalence and negative impacts of UP, understanding its underlying mechanisms and developing effective treatments are urgent challenges.…”

Section: Introductionmentioning

confidence: 99%

Data independent acquisition reveals in-depth serum proteome changes in uremic pruritus

Wen-Jing,

Rui-Zhi,

Si-Yuan

et al. 2024

Front. Physiol.

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Introduction: Uremic pruritus (UP) is a prevalent symptom in patients suffering from uremia, yet its underlying etiology and mechanisms remain incompletely elucidated. Given the significant incidence of UP, identifying specific alterations in proteins present in the blood of UP patients could offer insights into the potential biological pathways associated with UP and facilitate the exploration of biomarkers.Methods: In this study, we employed LC-MS/MS-based data-independent acquisition (DIA) mode to analyze serum samples obtained from 54 UP patients categorized as DKD-UP, HN-UP, and GN-UP (n = 18 for each subgroup), along with 18 uremic patients without pruritus (Negative) and 18 CKD patients without pruritus (CKD). Through DIA mode analysis, a total of 7075 peptides and 959 proteins were quantified. Within these, we identified four upregulated and 13 downregulated Differentially Expressed Proteins (DEPs) in DKD-UP versus Negative, five upregulated and 22 downregulated DEPs in HN-UP versus Negative, and three upregulated and 23 downregulated DEPs in GN-UP versus Negative. Furthermore, we conducted an intersection analysis of the DEPs across these three comparison groups to derive a set of common DEPs (COMP). Subsequently, a total of 67 common DEPs were identified in the three UP groups when compared to the CKD group, with 40 DEPs showing upregulation and 27 DEPs displaying downregulation.Results: Following Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Protein-Protein Interaction (PPI) analyses, we observed that the DEPs distinguishing UP from CKD were primarily associated with mitochondrial function (MT-CYB, PRDX2, TOMM22), inflammation (CD59, CSF1), renal injury (WFDC2), and neural function (CAP1, VGF).Discussion: Our findings contribute to a potential molecular comprehension of UP pathogenesis, shedding light on the identification of these DEPs as plausible biomarkers for UP.

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Chronic kidney disease-associated pruritus (CKD-aP) is associated with worse quality of life and increased healthcare utilization among dialysis patients

Cited by 7 publications

References 45 publications

CKD-Associated Pruritus is associated with greater use of antidepressants and anti-pruritus medications

CKD-Associated Pruritus is associated with greater use of antidepressants and anti-pruritus medications

Therapeutic effects of acupuncture therapy for kidney function and common symptoms in patients with chronic kidney disease: a systematic review and meta-analysis

Data independent acquisition reveals in-depth serum proteome changes in uremic pruritus

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