P1450UREMIC PRURITUS IN MAINTENANCE HEMODIALYSIS PATIENTS: ASSOCIATED FACTORS AND OUTCOME
Authors: Gjyzari (Velaj) Albana , Idrizi Alma , Koroshi Alketa , Gjata Margarita , Rroji (Molla) Merita , Lika Erjola , Haxhiu Denada , Barbullushi Myftar , Gjyzari Ilirjan 
Published: June 2020

Abstract

Background and Aims
Uremic pruritus (UP) is a frequent problem in hemodialysis patients. Despite the strong impact in the quality of life, its pathogenesis is not completely understood. Multiple factors are found associated with UP in several studies. The aim of this study was to evaluate the frequency and severity of pruritus in maintenance hemodialysis (MHD) patients, associated factors and outcome.

Method
This observational study was performed between January 2016 and December 2019. A total of 85 adult (age &gt;18 years) MHD patients were included in this study. Data were collected using a questionnaire. The severity of pruritus was scored according to the localization and the disturbance in usual work and sleep during the previous month. Mild: Episodic and localized pruritus without disturbance in usual work and sleep; Moderate: Generalized and continuous pruritus without sleep disturbance; Severe: Generalized and continuous pruritus with sleep disturbance. Some relevant demographic, clinical and laboratory parameters were evaluated. During follow up 2 patients underwent transplantation and 3 patients lost follow up. Mortality was the recorded outcome. We investigated whether demographic, clinical, biochemical parameters and outcome were correlated to UP.

Results
Pruritus was present in 61 % of the hemodialysis patients. Pruritic patients were older: median years 57.5(48.5-66.5) vs. 52(45-59) non pruritic; p=0.046 and male patients were significantly more affected (76.9% male vs. 23.1% female; p=0.015). Pruritic patients had shorter time on HD (mean years 5.2±3.4 vs. 7.8±4.2 non pruritic; p=0.003). The intensity of itching was mild, moderate and severe, in 35.3%, 20% and 5.9% of patients, respectively and severe pruritic patients had a significantly shorter time on HD (3.3±1.7 years; p=0.17). Xerosis was present in 84.6% of pruritic patients vs. 66.7% of non-pruritic; p=0.053. We didn’t find association with marital status, level of education, employment, presence of neuropathy, history of atopy, Diabetes Mellitus (DM). Urea redaction ratio (URR) was significantly lower in our pruritic patients: median 67(63-71) vs. 72(66-74) non-pruritic; p=049. Among biochemical parameters phosphorus (mg/dl) was significantly higher between pruritic patients: median 5.6(5.0-6.6) vs. 5.0(3.9-6.0) non-pruritic; p=0.051.
Univariate logistic regression analysis showed significant factors associated with UP: male gender OR=3.1, 95% CI: 1.2-8.0, p=0.017; time on HD OR=0.8, 95% CI: 0.73-0.95, p=0.006; phosphorus level OR=1.4, 95% CI: 1.0-2.0, p=0.034. Multivariate logistic regression analysis adjusted for confounders (age, DM) identified as independent factor associated with UP: male gender OR=3.9, 95% CI: 1.3-11.7, p=0.017 During 4 years follow up 29 (36.3%) patients died. Cox Regression analysis showed moderate pruritus as independent factor for mortality (64.7% dead vs. 35.3% survived within moderate pruritic patients) OR=3.2, 95% CI: 1.4-9.0, p=0.027 (fig. 1).

Conclusion
UP was a frequent complication in the first years of MHD patients and associated with a worse outcome. A multidimensional approach should be adapted for pruritic MHD patients. Data regarding the possible risk factors of male pruritic MHD patients must be followed closely.