Multidimensional pruritus assessment in hemodialysis patients

Abstract

BackgroundPruritus is a distressing, life-limiting symptom in chronic renal failure, affecting 40% of patients. This study aimed to determine uremic pruritus prevalence and investigate the multidimensional impact on hemodialysis patients.MethodsThis descriptive study was performed between March and June 2016. The study included 181 patients undergoing hemodialysis session, who reported pruritus in the prior month. Data were collected using the 5-D Itch Scale, which assesses pruritus based on 5 dimensions, i.e., degree, duration, direction, disability, and distribution, with a total score ranging from 5 (no itching) to 25 (maximum severity).ResultsPruritus prevalence was 49.3%. Patients had a mean score of 13.97 ± 4.11 (moderate severity). The daily duration was 6–12 h (40.3%), with direction “a little bit better but still present” (38.7%) and distribution on the “back, upper arms, chest, and abdomen.” Patients sleep, social life/leisure time, housework and errand were impacted “occasionally”. The score was higher in patients aged ≥65 years, those on hemodialysis for ≥15 or more years, and those undergoing afternoon hemodialysis. The duration of itching was significantly shorter in employed patients.ConclusionAssessment and management of itching symptoms in chronic renal failure are a clinical priority both for patients and for health care professionals. The results of this study highlight the importance of multidimensional assessment and support the need for development of standardized and patient-specific symptom management.

Association between Financial Hardship and Symptom Burden in Patients Receiving Maintenance Dialysis: A Systematic Review

“…Among the included studies, seven were conducted in Mainland China [27][28][29][30][31][32][33], and five each were conducted in Brazil [34][35][36][37][38], Turkey [39][40][41][42][43], and the USA [44][45][46][47][48] (Supplementary Material S3). Nine studies were from the Middle East [49][50][51][52][53][54][55][56][57], and seven were from South Asian countries [58][59][60][61][62][63][64].…”

“…One study assessed the sources of income [36], and another inquired about subjective perceptions of income level [50]. [75] Details not provided Multiple choices Gerogianni et al, 2018 [76] Multiple choices Perceived levels Hu et al, 2015 [28] Specific ranges Ibrahim and Salamony, 2008 [55] Dichotomized responses Jeon, Kim, and Kim, 2020 [77] Specific ranges Multiple choices [39] Yes/no Employment status was the most frequently used indicator of financial hardship among the included studies (n = 49). It is noteworthy that most of these indicators only reported employment status as a dichotomized variable, such as "employed" or "unemployed" (n = 27).…”

Chronic Kidney Disease-Associated Pruritus

“…The course of itching was “a little bit better, but still present” in 38.7%, while in 5%, it was “getting worse”, as explained by the patients.In 65.2% of cases 6–10 anatomical regions were involved, most commonly over the back followed by upper arm, chest, and abdomen. Palms, soles and face/head had very minimalinvolvement [ 44 ].…”

Have We Just Scratched the Surface? A Narrative Review of Uremic Pruritus in 2020

“… 101 Male sex was also identified as a predictor of pruritus in a study of 6137 patients on hemodialysis across 7 countries, 103 and as an independent risk factor for severe uremic pruritus in prospective studies of 1773 102 and 341 patients on hemodialysis. 100 Other studies defend that female sex predisposes to uremic pruritus, 22 , 104 - 108 but most were limited by small sample size. By contrast, 7 studies concluded that sex does not influence its development.…”