Uremic Pruritus: Prevalence and Impact on Quality of Life and Depressive Symptoms in Hemodialysis Patients

Abstract

Background End-stage renal disease (ESRD) is a major public health problem with many associated symptoms. Uremic pruritus (UP) develops in 40% of patients on hemodialysis and has major effects on the patient's life. It is also an independent risk factor for increased mortality, and its psychiatric implications remain poorly characterized in our local setup, where it tends to be underdiagnosed and undertreated. Objectives and rationale The study aims to report the prevalence of uremic pruritus in our study population and associate it with various patient parameters, which may define a subset of patients at high risk for this pruritus. We also assess the effects of uremic pruritus on the patient's quality of life (by using the Dermatology Life Quality Index; DLQI) and depressive symptoms (by using the Public Health Questionnaire; PHQ-9). Materials and methods It was a descriptive, cross-sectional study conducted in the nephrology unit of the multi-organ failure (MOF) center of the Holy Family Hospital (HFH), Rawalpindi, Pakistan, from February 2019 to June 2019, during which 173 male patients on hemodialysis were selected. Informed consent was taken from patients and other skin-related causes of pruritis were excluded. Uremic pruritus was defined as pruritis lasting for at least three months after the onset of ESRD. The 5-D, PHQ-9, and DLQI questionnaires were used to assess pruritis, depressive symptoms, and quality of life, respectively. Their Cronbach's Alpha values for 73 responses were 0.83, 0.81, and 0.71, respectively. The descriptive analysis was performed using SPSS v23.0 (IBM Corp, Armonk, NY, US). Spearman's rank-order correlation, independent samples t-test, and one-way analysis of variance (ANOVA) were used to analyze study variables. Results The prevalence of uremic pruritus was 49.1%, with many patients having generalized itching. Unemployment and longer disease duration predisposed the patients towards uremic pruritus, as the mean 5-D score in this subset were greater (p<0.05 in the independent samples t-test). The results of one-way ANOVA were significant (p<0.05), indicating higher 5-D scores in worsening categories of depressive symptoms and quality of life. Spearman's correlation matrix Open Access Original Article

<p>Relationship Between Depression and Quality of Life Among Vitiligo Patients: A Self-assessment Questionnaire-based Study</p>

“…Silpa-archa et al previous studies. 36,37 Therefore dermatologists should be concerned and keep in mind depressive symptoms when they detect and recognize the high DLQI score. Coping with depressive symptoms could improve QoL.…”

Self-reported Pruritus and Clinical, Dialysis-Related, and Patient-Reported Outcomes in Hemodialysis Patients

“…Philipp A Csomor, PhD4 , Thilo Schaufler, MD4 , Warren Wen, PhD5 , FrédériqueMenzaghi, PhD5 , Hugh C Rayner,MD6 , Takeshi Hasegawa, MD7 , Issa Al Salmi, MD8 , Saeed MG Al-Ghamdi, MD9 , Fitsum Guebre-Egziabher, MD10 , Pablo-Antonio Ureña-Torres, MD11 , Ronald L Pisoni, PhD 3 Authors' Affiliations: HR, IAS, TH, PC, SMA, FM, WW, NS, FGE; statistical analysis: RLP, AK; supervision or mentorship: RLP, TS, IAS, FGE. Each author contributed important intellectual content during manuscript drafting or revision, accepts personal accountability for the author's own contributions, and agrees to ensure that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.…”

Pruritus: Is there a grain of salty truth?

“…Symptom burden is life altering for patients with chronic kidney disease (CKD) and leads to poor quality of life (QOL). Uremic pruritus (UP) in itself affects approximately 50% of those with CKD 1–4 . After decades of investigation, the pathophysiology of UP remains poorly understood.…”

“…Uremic pruritus (UP) in itself affects approximately 50% of those with CKD. [1][2][3][4] After decades of investigation, the pathophysiology of UP remains poorly understood. Treatment options fail to provide effective and consistent relief.…”