Table 1.

Recent studies examining the prevalence, characteristics and outcomes of CKD-aP

Author, year	Study design and population	Itching and outcome tools	Prevalence	Characteristics	Outcome
Hemodialysis
Pisoni et al, 200618	18,801 adult HD patients from 308 dialysis centers in DOPPS I (1996–2001) and 322 centers in DOPPS II (2002–2004)	Itching: VRS (5-grade) Sleep quality: 3 self report questions QOL: SF-36 or SF-12	Moderate to extreme pruritus in 42% of patients in DOPPS II and 45% in DOPPS I	Higher adjusted odds of moderate to extreme pruritus: male, lung disease, CHF, neuro disease, ascites, hepatitis C; higher Ca, phos, WBC count, and lower albumin Lower adjusted odds: high serum ferritin, ESRD vintage ≤3 months or lived with ESRD >10 years	Patients with moderate to extreme pruritus compared to none: 1. 13% higher adjusted mortality risk in DOPPs I, 21% higher in DOPPS II 2. Feeling drained (AOR = 2.3–5.3) 3. Depression (AOR = 1.3–1.7) 4. Poor sleep (AOR = 1.4–4.0) 5. Worse QOL. No itch had MCS/PCS scores 8.6/6.4 points higher than those with extreme itchiness
Narita et al, 200630	1,773 adult Japanese HD patients followed for 2 years or until death	Itching: VAS: no/mild <4, Moderate =4–6.9, Severe ≥7. Frequency (graded 1–5) Sleep disturbance (graded 1–4)	No/mild =19.5%, moderate =27.9%, severe VAS =25.5%	Male, BUN, β2-microglobulin, Ca, and phos were risk factors for severe pruritus (adjusted). Low Ca and PTH associated with reduced risk	Severe pruritus is an independent predictor of death (HR =1.60) In patients with severe pruritus, >70% complained of grade 2–4 sleep disturbance (unadjusted)
Mathur et al, 20103	103 US adult HD patients followed for 3.5 months	Itching severity: VAS, and NRS QOL: Skindex-10, BII, self-assessed Sleep disturbance: SSMOS, Itch MOS Depression: BDI	Daily or nearly daily itching in 84%; ongoing (>1 year) in 59%	Younger age associated with more severe pruritus	Changes in itching severity ≥20% associated with reduced HR-QOL Severity associated with sleep loss Severity was associated with higher BDI total scores (10.8 for <50 mm, 12.7 for 51–70 mm, and 17.7 for >71 mm)
Ramakrishnan et al, 201420	71,000 US HD and PD patients	Itching severity: VRS scale from the KDQOL survey (5-grade) QOL: SF-12	60% “some itching”; 14.5% “very much or extremely bothered”	Itching associated with: younger, female, DM, CAD, COPD, liver disease, dialysis vintage, BMI; lower Hgb and albumin; higher Ca, phos, PTH, ferritin	Itching severity associated with: 1. Decrease in QOL 2. Increased medication use: (IV antibiotic, IV ESA, and IV iron) 3. Increase in missed HD sessions
Kimata et al, 201419	6,480 Japanese HD patients from JDOPPS (1996–2008); 60–65 facilities followed for a median of 1.9 years	Itching severity: VRS (5 grade) QOL: SF-36, SF-12 Sleep quality: self report: “very bad” or “fairly bad”	44% of patients experienced moderate to severe itching	Higher adjusted odds of moderate to extreme pruritus: older, male, smoking, HTN, AVG, ascites, hepatitis C, Ca, phos, or PTH levels; lower albumin, aluminum levels Lower odds: ESRD ≤1 year	Patients with moderate to extreme pruritus compared to no/mild pruritus: 1. Feel drained (AOR =2.2–5.8) 2. Poor sleep (AOR =1.9–3.7) 3. Lower QOL mental and physical composite scores (adjusted) Pruritus in HD patients associated with a 23% higher adjusted mortality (p=0.09)
Pre-dialysis CKD
Solak et al, 201699	402 Turkish patients with CKD 2–5	Presence of itching: Previously defined by Zucker et al113 Itching severity: VAS	18.9%	Pruritus associated with furosemide, lower Hgb, eosinophils and xerosis cutis. ACEi or ARB not associated (unadjusted)	Itching severity not associated with CKD stage
Khanna et al, 201027	150 Indian CKD 3–5 patients, and 50 on dialysis	Itching severity: VAS, and by 2 dermatologists	28.7%, pre-dialysis; 58%, dialysis	Pruritus associated with dialysis vintage, xerosis, and high Ca and phos	Increased prevalence of pruritus with worsening kidney disease
Peritoneal dialysis
Min et al, 201622	425 HD and 223 PD patients from Korea	Itching intensity: VAS, Modified Pauli-Magnus scale90	PD > HD – 62.6% vs 48.3% with VAS ≥1	Pruritus negatively correlated with Kt/V and positively correlated with dialysis vintage, BP, cholesterol (adjusted)	PD associated with higher odds of pruritus than HD (AOR =1.76) Pruritus associated with higher BMI (AOR =1.06)
Li et al, 201521	362 Chinese PD patients	Itching intensity: VAS (no =0, mild to moderate =1–5, severe >5) Sleep quality: PSQI Depression: BDI QOL: SF-36	No =34.8%, mild to moderate =52.5%, severe = 12.7%,	Pruritus associated with dialysis vintage (AOR =1.04) and higher PTH (AOR =1.3)	Severe pruritus associated with higher 1. PSQI, BDI (adjusted) 2. lower SF-36 PCS scores – (unadjusted)

Abbreviations: CKD-aP, chronic kidney disease-associated pruritus; HD, hemodialysis; DOPPS, dialysis outcomes and practice patterns study; VRS, verbal rating scale; QOL, quality of life; SF, short form; CHF, congestive heart failure; Ca, calcium; phos, phosphorus; WBC, white blood cell; ESRD, end-stage renal disease; AOR, adjusted odds ratio; MCS, mental component summary; PCS, physical component summary; VAS, visual analog scale, BUN, blood urea nitrogen; PTH, parathyroid hormone; NRS, numeric rating scale; BII, brief itching inventory; SSMOS, sleep survey medical outcomes survey; MOS, medical outcomes survey; BDI, Beck’s depression inventory; KDQOL, kidney disease QOL; DM, diabetes mellitus; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; BMI, body mass index; Hgb, hemoglobin; HTN, hypertension; AVG, arteriovenous graft; CKD, chronic kidney disease; ACEi, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; PD peritoneal dialysis; PSQI, pittsburgh sleep quality index; HR, health related; IV, intravenous; ESA, erythropoietin.