Clinical Characteristics of Itch in Renal Transplant Recipients

Abstract

Background: Chronic itch is the most common symptom in dermatology. End-stage renal disease-associated chronic itch (ESRDCI) is a common burden affecting up to 35% of patients treated with hemodialysis. Kidney transplant (KTx) is believed to be the best renal replacement therapy leading to the elimination of ESRDCI. The study was undertaken to characterize and assess the prevalence of itch among patients after renal transplantation.Methods: Between October 2019 and January 2020, we analyzed the data of 197 patients comprising 121 males (61.4%) and 76 females (38.6%) and aged 54.5 ± 13.6 years. The data collection was performed with a specially designed questionnaire. Level of itch after renal transplantation was assessed with the use of a Numeral Rating Scale, a Visual Rating Scale, and 4-Item Itch Questionnaire. Moreover, the previous 3 days of itching were evaluated.Results: The patients suffered from chronic renal disease for 20.2 ± 12.3 years, with a mean time of pre-transplant dialysis of 2.6 ± 2.4 years and a mean time after the KTx of 8.0 ± 6.5 years. The itch was present in 38.6% of the patients during the hemodialysis, and in 73.7% of cases, the itch ceased completely after the successful transplantation. Moreover, only 2.63% of the cases had no improvement. Nevertheless, the itch was reported in 42 (21.3%) renal transplant recipients (RTR), and in 22 (52.4%) cases, the itch appeared after transplantation. The majority of patients suffering from itch were women (54.8%). Itch in the last 3 days was reported in 21 patients. The itch's severity was assessed with a numerical rating scale (NRS), with the worst severity measured at 6 ± 2.2 points indicating moderate itch. In most cases (57.1%), itch affected multiple body areas. Extremities (50%) and the back (50%) were among the most frequently affected areas. The sensation had a mostly short duration and was most frequently reported in the evening. Only eight patients suffered for the whole day. Hot water was the most frequently reported (16.7%) alleviating factor, whilst sweat was responsible for itch aggravation in 35.9% of cases.Conclusion: Our analysis on representative patients' population indicates that itch after KTx is an important problem. Moreover, it is worth noting that more than half of the RTR did not suffer from itch during dialysis.

Itch in Adult Population with Type 2 Diabetes Mellitus: Clinical Profile, Pathogenesis and Disease-Related Burden in a Cross-Sectional Study

“…Standardized questionnaires and scales were completed by patients in order to assess the itch intensity [Numerical Rating Scale (three days, 24hours) (NRS; 0–10 points)] and the Four-item Itch Questionnaire [ 11 , 12 , 13 ] (4IIQ; 3–19 points). NRS cut-off points are as follows: 1– < 3 points represent a mild itch, 3–7 points a moderate itch, ≥7–9 points a severe itch, and ≥9 points very severe itch [ 14 ].…”

Chronic Kidney Disease-Associated Itch (CKD-aI) in Children—A Narrative Review

“…Following RTx, still no guarantee can be made on the disappearance of CKD-aI. Nevertheless, it bothers significantly lower fraction of adult patients than previously [ 26 , 27 , 28 ]. Based on our personal experience, children initially suffering from CKD-aI also benefit from RTx, with the majority of young recipients finally free from this symptom (unpublished data).…”

“…Based on recent data, it affects 42–44% of adults undergoing haemodialysis (HD) [ 22 , 23 ], while in patients undergoing peritoneal dialysis (PD) the percentages exceed 60% [ 24 , 25 ]. Patients who underwent successful renal transplantation (RTx) still complain of CI in up to 32% cases, albeit the percentages are lower than during their previous HD sessions [ 26 , 27 , 28 ]. However, CKD-aI may also bother CKD patients not yet on dialysis, including those with earlier stages of the disease [ 23 , 29 , 30 ].…”

Chronic Kidney Disease-Associated Pruritus

“…A total of 42 (21.3%) renal transplant recipients reported itch, of which 22 (52.4%) cases reported the appearance of itch following transplantation. However, those with itching after renal transplant responded well to HD [ 81 ].…”