4.2 Review

Novel approach to unpleasant symptom clusters surrounding pruritus in patients with chronic kidney disease and on dialysis therapy

Journal

CURRENT OPINION IN NEPHROLOGY AND HYPERTENSION
Volume 31, Issue 1, Pages 63-71

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MNH.0000000000000752

Keywords

chronic kidney disease; dialysis; pruritus; symptom cluster; unpleasant symptom

Funding

  1. National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health [U01DK123787-S1]
  2. National Institute of Nursing Research of the National Institutes of Health [K23NR018482]

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CKD-aP significantly impairs HRQoL in patients with ESKD undergoing dialysis and is associated with adverse clinical outcomes. Despite being underrecognized and undertreated, clinical studies have shown that reduction of itch intensity may alleviate other associated symptoms, such as poor sleep quality. CKD-aP and its associated symptoms are inadequately managed in clinical practice, highlighting the need for greater understanding and awareness to improve overall symptom management and HRQoL in dialysis patients.
Purpose of review Chronic kidney disease-associated-pruritus (CKD-aP) is a common symptom in patients with end-stage kidney disease (ESKD) undergoing dialysis. CKD-aP typically occurs alongside other debilitating symptoms and may comprise so-called 'symptom clusters' which have synergistic effects that adversely impact patient health-related quality of life (HRQoL). Importantly, symptoms in a cluster may share a common biological mechanism. Here we review the clinical impact of CKD-aP and its association with other symptoms reported by dialysis patients. The clinical benefits of treating pruritus and its potential impact on other symptoms are also addressed. Recent findings Studies have shown CKD-aP significantly impairs HRQoL in patients with ESKD undergoing dialysis and is associated with adverse clinical outcomes, including increased risk of infections, hospitalizations, and mortality. Despite these negative effects, CKD-aP remains underrecognized and undertreated in clinical practice. CKD-aP is frequently associated with other symptoms, including disturbed sleep/poor sleep quality, anxiety, depression, and pain. Clinical studies of antipruritic therapies show that reduction of itch intensity may also alleviate other associated symptoms, such as poor sleep quality. CKD-aP and its associated symptoms are inadequately managed in clinical practice. Greater understanding and awareness of CKD-aP and its surrounding symptom clusters in dialysis patients may improve their overall symptom management and HRQoL.

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