#4866 PREVALENCE AND SEVERITY OF CHRONIC KIDNEY DISEASE ASSOCIATED PRURITUS IN A DIALYSIS NETWORK IN WEST GERMANY
Authors: Krüger Thilo , Schunck Bastian 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease-associated pruritus (CKD-aP) is a troubling and in some cases debilitating problem for patients with CKD and end-stage renal disease with potential impact on patients’ quality of life (QoL). Frequency of CKD-aP with at least a medium intensity has been reported to be present in approximately 40% of dialysis dependent patients in European countries and 26% in Germany. This work intended to update prevalence and disease severity in a large dialysis network in West Germany.

Method
We performed a cross-sectional study addressing maintenance dialysis patients (both hemodialysis and peritoneal dialysis) in 23 dialysis facilities in West Germany with a total of approximately 1,500 dialysis patients. After ethical approval, a questionnaire was distributed to all dialysis patients asking for presence of pruritus and if present about itch duration, dialysis vintage, pruritus severity, communication patterns, therapeutic attempts and impact on quality of life (QoL). Pruritus intensity was assessed using the worst itch numeral rating scale (WI-NRS).

Results
From May to July 2022, 919 patients completed and returned the questionnaire. 31.9% were female, 55.4% male and 12.7% did not disclose their gender. Overall, 223 (23.7%) reported presence of pruritus of any severity with 90.1% having pruritus for at least 6 weeks duration. 159 (17.4%) of all patients reported at least moderate itch intensity (WI-NRS ≥4) and 70 (7.7%) a severe itch intensity (WI-NRS ≥7). Dialysis vintages of &lt;1 year, 1–2 years, 2–4 years and &gt;4 years were reported by 15.8%, 16.2%, 25.7% and 36.9% of patients with pruritus, respectively. Approx. 71% of all patients with any intensity of pruritus reported to be unaware of origin of pruritus, the remainder gave various reasons with a majority mentioning CKD or dialysis associated reasons. 62 of the 223 with pruritus (27.8%) reported having received treatments of which 14 (22.6%) stated no, 27 (43.5%) partial and 17 (27.4%) good response. Most frequent therapy category mentioned was emollients (14) with a mixed effect: 4 reported no effect, 6 some and 2 a good effect. Of those having received antihistamines, all reported good response (4). 132 (59.2%) of patients with pruritus communicated the presence with someone, 89 of those (67.4%) with their nephrologist. Of the 223 patients with pruritus 214 (96.0%) reported any stage of impact on their QoL in at least one of the categories sleep, social life, household, or work. Highest frequency given was in social life (180/223) and lowest frequency in sleep disturbances (74/223).

Conclusion
Prevalence of CKD-aP of at least medium intensity was lower than previously reported for Germany, continuing the previous trend seen in DOPPS for decreasing prevalences. The patient awareness of association of pruritus to CKD is still low. A positive correlation of itch prevalence in CKD may exist to dialysis vintage. Compared to DOPPS data from 2015, fewer patients communicated itch at all but in case the nephrologist was most frequently addressed. Treatment attempts seem to be still rare and were conducted only in a minority of patients with CKD-aP. Impact of CKD-aP on QoL was usually present.