Table 1.

Select studies examining the prevalence, characteristics, and outcomes of chronic kidney disease–associated pruritus (CKD-aP)

Author, yr	Study design and population	Itching and outcome tools	Prevalence	Characteristics		Outcomes
Hemodialysis
Rayner et al., 20173	35,452 HD patients from 17 countries from DOPPS I–V (1996–2015); 6256 HD patients from DOPPS V (2012–2015); 268 medical directors	Itching severity: VRS (5-grade); QOL: Skindex-10 scale (6-grade); intervention by medical directors: first, second, and third line for acute and chronic use	74% with some itch, 46% moderate–extreme (DOPPS I); decreased to 69% some and, 37% moderate–extreme (DOPPS V)	Higher AOR of moderate to severe pruritus with older age, higher CRP, low serum albumin, presence of hepatitis B or C; No association with Phos, Ca, Ca-Phos product, PTH, Kt/V, or hemodiafiltration		Patients very much or extremely bothered by, also bothered by dry skin (84%), restless sleep (60%) Medical directors underestimated pruritus in 69% of facilities 57% of medical directors used oral antihistamines for first-line treatment Gabapentin was used by 45% as first, second, or third treatment
Ramakrish-nan et al., 201321	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 (i) Decrease in QOL (ii) Increased medication use: (i.v. antibiotic, i.v. ESA, and i.v. iron) (iii) Increase in missed HD sessions
Kimata et al., 201422	6480 Japanese HD patients from JDOPPS (1996–2008); 60–65 facilities followed for a median of 1.9 yr	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 AOR of moderate to extreme pruritus: older, male, smoking, HTN, AVG, ascites, hepatitis C; higher Ca, Phos, or PTH levels; lower albumin, aluminum levels Lower odds: ESRD ≤ 1 yr		Patients with moderate to extreme pruritus compared to no/mild pruritus (i) Feel drained (AOR = 2.2–5.8) (ii) Poor sleep (AOR = 1.9–3.7) (iii) Lower QOL mental and physical composite scores (adjusted) Pruritus in HD patients associated with a 23% higher adjusted mortality (P = 0.09)
Pisoni et al., 200613	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 AOR of moderate to extreme pruritus: male, lung disease, CHF, neuro disease, ascites, hepatitis C; higher Ca, Phos, WBC; lower albumin Lower adjusted odds: high serum ferritin, ESRD vintage ≤3 mo or lived with ESRD >10 yr		Patients with moderate to extreme pruritus compared to none (i) 13% higher adjusted mortality risk in DOPPs I, 21% higher in DOPPS II (ii) Feeling drained (AOR = 2.3–5.3) (iii) Depression (AOR = 1.3–1.7) (iv) Poor sleep (AOR = 1.4–4) (v) Worse QOL. No itch had MCS/PCS scores 8.6/6.4 points higher than those with extreme itchiness
Narita et al., 200623	1773 adult Japanese HD patients followed for 2 yr 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; higher 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, more than 70% complained of grade 2–4 sleep disturbance (unadjusted).
Pre-dialysis CKD
Sukul et al., 20197	3780 patients with CKD 3–5 from the US, Brazil, and France	Itching severity: NRS (5-grade), PCS score; QOL: SF-36; Depression: CES-D short form, MCS score	24% with moderate to severe itching		Higher APR of moderate to extreme pruritus: older age, female sex, stage-5 CKD, lung disease, DM, physician-diagnosed depression; higher Phos and lower Hgb; Lower l with male sex	Patients with extreme pruritus compared to none (i) Lower QOL—7.6- and 6.2-point decrease in PCS and MCS scores, (ii) More depression (APR = 2.55), (iii) More restless sleep (APR = 2.1)
Peritoneal dialysis
Min et al., 201624	425 HD and 223 PD patients from Korea	Itching intensity: VAS, modified Pauli-Magnus scale25	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., 201526	362 Chinese PD patients	Itching intensity: VAS (No = 0, mild–moderate = 1–5, severe >5) Sleep quality: PSQI Depression: BDI QOL: SF-36	No = 34.8%; Mild–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 (i) PSQI, BDI (adjusted) (ii) Lower SF-36 PCS scores (unadjusted)

AOR, adjusted odds ratio; APR, adjusted prevalence ratio; AVG, arteriovenous graft; BDI, Beck’s Depression Inventory; BMI, body mass index; BP, blood pressure; BUN, blood urea nitrogen; Ca, calcium; CAD, coronary artery disease; CES-D, Center for Epidemiologic Studies Depression Scale; CHF, congestive heart failure; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; DM, diabetes mellitus; DOPPS, Dialysis Outcomes and Practice Patterns Study; ESA, erythropoiesis-stimulating agents; ESRD, end-stage renal disease; HD, hemodialysis; Hgb, hemoglobin; JDOPPS, Japanese Dialysis Outcomes and Practice Patterns Study; KDQOL, Kidney Disease quality of life; HTN, hypertension; MCS, Mental Component Summary; MCS; Mental Component Summary: NRS, Numeric Rating Scale; PCS, Physical Component Summary; PD, peritoneal dialysis; PCS, Physical Component Summary; Phos, phosphorus; PSQI, Pittsburgh Sleep Quality Index; PTH, parathyroid hormone; QOL, quality of life; SF-12, 12-item short-form health survey; SF-36, 36-item short-form health survey; VAS, visual analog scale; VRS, verbal rating scale; WBC, white blood cell.