Hemodialysis Patients with Pruritus and Insomnia Have Increased Risk of Death

Orășan, Olga Hilda; Mureșan, Flaviu; Moţ, Augustin C.; Taut, Adela Sitar; Minciună, Iulia; Coste, Sorina Cezara; Negrean, Vasile; Orășan, Remus; Cozma, Angela

doi:10.1159/000505147

Cited by 11 publications

(9 citation statements)

References 17 publications

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“…However, in contrast to what might be expected based on previous research about the effect of itching on clinical outcomes over time (e.g. mortality and hospitalizations) [ 5 , 8 , 27 , 28 ], this study showed no faster deterioration of HRQOL in patients with (persistent) itching during 2 years of follow-up. Future research should investigate these relationships using a longer follow-up period.…”

Section: Discussioncontrasting

confidence: 99%

“…Additionally, several treatment trials showed that a reduced itching intensity may result in improved HRQOL scores and sleep quality [ 5 ]. Furthermore, the literature suggests that better management of itching and HRQOL might even result in improved clinical outcomes, such as mortality and hospitalizations [ 5 , 8 , 27 , 28 ]. The need for and potential benefits of a treatment for itching are thus evident.…”

Section: Discussionmentioning

confidence: 99%

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Itching in dialysis patients: impact on health-related quality of life and interactions with sleep problems and psychological symptoms—results from the RENINE/PROMs registry

Willik

Lengton

Hemmelder

et al. 2022

Nephrology Dialysis Transplantation

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Background Itching (pruritus) is common in dialysis patients, but little is known about its impact on health-related quality of life (HRQOL), sleep problems and psychological symptoms. This study investigates the impact of itching in dialysis patients by looking into the persistence of itching, the effect of itching on the course of HRQOL, and the combined effect of itching with sleep problems and with psychological symptoms on HRQOL. Methods Data were obtained from the RENINE/PROMs registry and included 2978 dialysis patients who completed patient-reported outcome measures between 2018–2020. Itching, sleep problems and psychological symptoms were assessed with the DSI, and HRQOL with the SF-12. Effects of itching on HRQOL and interactions with sleep problems and psychological symptoms were investigated cross-sectionally and longitudinally, using linear regression and linear mixed models. Results Half of the patients experienced itching and in 70% of them, itching was persistent. Itching was associated with a lower physical and mental HRQOL (-3.35 [95%CI: -4.12; -2.59] and -3.79 [95%CI: -4.56; -3.03]). HRQOL remained stable during two years and trajectories did not differ between patients with or without itching. Sleep problems (70% vs 52%) and psychological symptoms (36% vs 19%) were more common in patients with itching. These symptoms had an additional negative effect on HRQOL, but did not interact with itching. Conclusions The persistence of itching, its impact on HRQOL over time, and the additional effect on HRQOL of sleep problems and psychological symptoms, emphasize the need for recognition and effective treatment of itching to reduce symptom burden and improve HRQOL.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Itching in dialysis patients: impact on health-related quality of life and interactions with sleep problems and psychological symptoms—results from the RENINE/PROMs registry

Willik

Lengton

Hemmelder

et al. 2022

Nephrology Dialysis Transplantation

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“…Soleymanian et al found that pruritus was a significant predictor for insomnia [21]. Similarly, Orasan et al found that survival at 20 months was lower in patients with both pruritus and insomnia [22], while in another study low quality of sleep was found to be related to increased mortality in hemodialysis patients [23]. It can be assumed that uremic pruritus has a negative effect on the general health functioning of hemodialysis patients since it is associated with systemic inflammation and cardiovascular mortality [24].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Insomnia in Patients Undergoing Hemodialysis

Benetou¹,

Alikari²,

Vasilopoulos³

et al. 2022

Cureus

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Introduction: Insomnia is the most common sleep disorder among patients on hemodialysis and has a strong relation with fatigue, depression, low immune system, increased risk of cardiovascular problems, and low quality of life. The aim of this study was to explore the factors associated with insomnia in patients undergoing hemodialysis.Methods: In this cross-sectional study, 100 patients on hemodialysis (75 males and 25 females) from a hemodialysis center in Greece were included. Insomnia was assessed via the "Athens Insomnia Scale (AIS)" and a questionnaire about demographic and clinical characteristics. The Kruskal-Wallis, Mann-Whitney tests, and Spearman's rho criterion were used to evaluate the association between insomnia score and patients' characteristics. Multiple linear regression was performed to assess the effect of characteristics on patients' insomnia.Results: Statistically significantly high levels of insomnia were found in patients over the age of 60 years (p = 0.002), in divorced/widowed patients (p = 0.007), in patients who had comorbid diseases (p = 0.001), in patients who felt tired after hemodialysis (p = 0.001), in those who had continuous fatigue (p = 0.001) and change in body image (p = 0.003), in those who often had itching (p = 0.007) and stiffness in joints (p = 0.001) and in patients who had limitations in the clothes they could wear (p = 0.001).Conclusions: The findings of this study showed that insomnia had a strong association with increased age of patients, comorbidities, fatigue, change in body appearance, pruritus, and limitation in clothes they could wear. Therefore, there is a necessity for early assessment of sleep quality and effective treatment of sleep disorders in hemodialysis patients in order to reduce morbidity and mortality and improve the quality of their life.

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“…This study aimed to investigate sleep quality and pruritus among HD patients and their relationship. It should be noted that a previous publication found that pruritus and poor sleep quality significantly affect survival in this population [23]. The current study contains important findings from a developing country regarding the commonness of pruritus in hemodialysis patients and its devastating effect on sleep.…”

Section: Discussionmentioning

confidence: 69%

Prevalence of pruritus associated with hemodialysis and its association with sleep quality among hemodialysis patients: a multicenter study

et al. 2022

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Background CKD-associated pruritus (chronic kidney disease-associated pruritus) is one of the common symptoms in hemodialysis patients, with a major effect on sleep quality because it occurs at night. The main objective of this study is to determine the prevalence of pruritus among hemodialysis (HD) patients and its impact on sleep and investigate factors associated with pruritus and sleep quality. Methods A cross-sectional study began in January until March of 2021 in HD centers of four different hospitals in the West Bank, Palestine. Patients with HD aged 18 years or older were included in our investigation. Pruritus and sleep problems were assessed by a 5-D itching score and the Pittsburgh Sleep Quality Index (PSQI) score. Results Of 280 HD patients, 250 were accepted to participate in our study. The mean age of the participants was (54.9 ± 15.08). 62.8% were male, and 42.4% of the participants were elderly (age ≥ 60yrs). Pruritus was observed in 121 (48.4%). The 5-D itching score had a median [IQR] of 5.0[5.0–15.0], and 57.2% had a score ≥ 6 points. Severe pruritus was reported in 28.1% of patients. The score was significantly associated with residency (p = 0.033) and chronic comorbidities (p = 0.026). The PSQI score has a median [IQR] of 8[5–12], and 66.4% are poor sleepers with a score of < 5. The score was significantly associated with age (p = 0.017), marital status (p = 0.022), occupational status (p = 0.007), chronic comorbidities (p > 0.001), chronic medication (p = 0.008), severity of pruritus (p = 0.003) and duration of pruritus (p = 0.003). Regression analysis showed that the 5-D itching score and the total number of comorbidities were significantly associated with the PSQI score. Conclusions Pruritus is a widespread complication among HD patients in Palestine. Pruritus also has major effects on sleep quality and is associated with poor sleep quality.

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Hemodialysis Patients with Pruritus and Insomnia Have Increased Risk of Death

Cited by 11 publications

References 17 publications

Itching in dialysis patients: impact on health-related quality of life and interactions with sleep problems and psychological symptoms—results from the RENINE/PROMs registry

Itching in dialysis patients: impact on health-related quality of life and interactions with sleep problems and psychological symptoms—results from the RENINE/PROMs registry

Factors Associated With Insomnia in Patients Undergoing Hemodialysis

Prevalence of pruritus associated with hemodialysis and its association with sleep quality among hemodialysis patients: a multicenter study

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