Impact of chronic kidney disease-associated pruritus on quality of life in maintenance hemodialysis patients

Background. Chronic kidney disease-associated pruritus (CKD-aP) can significantly impair quality of life by negatively affecting patient psycho-emotional well-being and sleep quality, while also increasing the risk of hospitalizations and mortality. In Russia, this issue remains understudied.

Objective: to assess the prevalence of pruritus and its impact on various aspects of quality of life in a Russian cohort of patients with CKD receiving maintenance hemodialysis.

Methods. The cross-sectional study included 225 patients from two dialysis centers with who has been receiving hemodialysis for more than 3 months. The presence and severity of CKD-aP were assessed using the following validated instruments: WI-NRS, Skindex-16, Itch MOS, and the 5-D Itch Scale.

Results. CKD-aP was identified in 52% of the patients, with 16% [95% CI: 11; 21] experiencing moderate-to-very severe pruritus (WI-NRS ≥4). The most commonly affected body areas were the back (53%), head (35%), shins (32%), and thighs (25%). Patients with CKD-aP, particularly those with moderate-to-severe pruritus, demonstrated more pronounced sleep disturbances. Sleep Problem Index II (SPI-II) scores were 13.3 [Q1-Q3: 0.0; 33.3] in patients without pruritus, 20 [6.7; 33.3] in those with mild pruritus, and 33.3 [20.0; 60.0] in those with moderate-to-severe pruritus (p=0.001). Patients with moderate-to-severe pruritus also had significantly higher Skindex-16 total and subscales score compared to those with mild pruritus: total score 20.7 [8.9; 35.3] vs. 7.4 [2.8; 15.5] (p<0.001), emotional subscale 14.3 [2.4; 47.6] vs. 5.2 [0.0; 16.7] (p<0.001), and symptomatic subscale 31.3 [12.5; 50.0] vs. 12.5 [4.2; 20.8] (p<0.001). The total score on the 5-D Itch Scale was also higher in patients with CKD-aP, particularly in the moderate-to-severe group: 6.0 [5.0; 8.0] in patients without pruritus, 10.0 [8.0; 11.0] in those with mild pruritus, and 13.0 [11.0; 15.0] in those with moderate-to-severe pruritus (p<0.001). Patients with pruritus had higher creatinine levels: 804.8 (217.4) μmol/L vs. 727.8 (197.8) μmol/L in patients without pruritus, p=0.0091.

Conclusions. CKD-aP is highly prevalent in a Russian cohort of patients receiving maintenance hemodialysis. Patients with pruritus, particularly of severe pruritus, experience substantial impairment in overall quality of life and across multiple domains, including sleep, daily activities, and emotional well-being.

1. Wang CCY, Wu HHL, Ponnusamy A et al. Pruritus in Chronic Kidney Disease: An Update. Allergies. 2022;2(3): 87-105. DOI: 10.3390/allergies2030009

2. Hu X, Sang Y, Yang M et al. Prevalence of chronic kidney disease-associated pruritus among adult dialysis patients: A meta-analysis of cross-sectional studies. Medicine (Baltimore). 2018;97(21):e10633. DOI: 10.1097/MD.0000000000010633

3. Sutaria N, Adawi W, Goldberg R et al. Itch: Pathogenesis and treatment. J Am Acad Dermatol. 2022;86(1):17-34. DOI: 10.1016/j.jaad.2021.07.078

4. Rayner HC, Larkina M, Wang M et al. International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis. Clin J Am Soc Nephrol. 2017;12(12):2000-2007. DOI: 10.2215/CJN.03280317

5. Scherer JS, Charlotte T, Pisoni RL et al. CKD-Associated Pruritus and Clinical Outcomes in Nondialysis CKD. Kidney Medicine. 2023;6(1):100754. DOI: 10.1016/j.xkme.2023.100754

6. Sukul N, Speyer E, Tu C et al. Pruritus and Patient Reported Outcomes in Non-Dialysis CKD. Clin J Am Soc Nephrol. 2019;14(5):673-681. DOI: 10.2215/CJN.09600818

7. Krajewski PK, Krajewska M, Szepietowski JC. Pruritus in renal transplant recipients: Current state of knowledge. Adv Clin Exp Med. 2020;29(6):769-772. DOI: 10.17219/acem/122174

8. van der Willik EM, Lengton R, Hemmelder MH et al. Itching in dialysis patients: impact on health-related quality of life and interactions with sleep problems and psychological symptoms-results from the RENINE/PROMs registry. Nephrol Dial Transplant. 2022;37(9):1731-1741. DOI: 10.1093/ndt/gfac022

9. Makar M, Smyth B, Brennan F. Chronic Kidney Disease-Associated Pruritus: A Review. Kidney Blood Press Res. 2021;46(6):659-669. DOI: 10.1159/000518391

10. Huet F, Taieb C, Corgibet F et al. Pruritus, Pain, and Depression Associated with the Most Common Skin Diseases: Data from the French Study "Objectifs Peau". Dermatology. 2022;238(3):448-453. DOI: 10.1159/000518220

11. Ahdoot R, Kalantar-Zadeh K, Burton J, Lockwood M. Novel approach to unpleasant symptom clusters surrounding pruritus in patients with chronic kidney disease and on dialysis therapy. Curr Opin Nephrol Hypertens. 2022;31(1):63-71. DOI: 10.1097/MNH.0000000000000752

12. Faucon AL, Clase CM, Rydell H et al. Burden of CKD-Associated Pruritus and Adverse Clinical Outcomes in Patients Receiving Dialysis: The Stockholm CREAtinine Measurements (SCREAM) Project. Am J Kidney Dis. 2024; S0272-6386(24)00891-6. DOI: 10.1053/j.ajkd.2024.05.013

13. Sukul N, Karaboyas A, Csomor PA et al. Self-reported Pruritus and Clinical, Dialysis-Related, and Patient-Reported Outcomes in Hemodialysis Patients. Kidney Med. 2020;3(1):42-53. DOI: 10.1016/j.xkme.2020.08.011

14. Aresi G, Rayner HC, Hassan L et al. Reasons for Underreporting of Uremic Pruritus in People With Chronic Kidney Disease: A Qualitative Study. J Pain Symptom Manage. 2019;58(4):578-586. DOI: 10.1016/j.jpainsymman.2019.06.010

15. Nikitina TP, Parshina EV, Tolkach AD et al. Approbation of a series of questionnaires for comprehensive assessment of pruritus and its impact on quality of life in patients with chronic kidney disease receiving hemodialysis. Nephrologу and Dialуsis. 2023;25(4):527-540. DOI: 10.28996/2618-9801-2023-4-527-540 (In Russian)

16. Potekaev NN, L'vov AN, Zhukova OV i dr. Ispol'zovanie ocenochnyh shkal dlja pacientov s kozhnym zudom: Metodicheskie rekomendacii № 7. Moskva, 2021. 36 s. (In Russian)

17. Chren MM. The Skindex instruments to measure the effects of skin disease on quality of life. Dermatologic Clinics. 2012.30(2):231-236, xiii. DOI: 10.1016/j.det.2011.11.003

18. Chren MM, Lasek RJ, Sahay AP, Sands LP. Measurement properties of Skindex-16: a brief quality-of-life measure for patients with skin diseases. Journal of Cutaneous Medicine and Surgery. 2001.5(2):105-110. DOI: 10.1007/BF02737863

19. Mathur V, Lindberg J, Germain M et al. A longitudinal study of uremic pruritus in hemodialysis patients. Clinical journal of the American Society of Nephrology. 2010.5:1410-1419. DOI: 10.2215/CJN.00100110

20. Elman S, Hynan LS, Gabriel V, Mayo MJ. The 5-D itch scale: a new measure of pruritus. British Journal of Dermatology. 2009.162(3):587-593. DOI: 10.1111/j.1365-2133.2009.09586.x

21. Atherton PJ, Burger KN, Loprinzi CL et al. Using the Skindex-16 and common terminology criteria for adverse events to assess rash symptoms: results of a pooled-analysis (N0993). Support Care Cancer. 2012.20(8):1729-1735. DOI: 10.1007/s00520-011-1266-x

22. Secrest AM, Hopkins ZH, Frost ZE et al. Quality of life assessed using Skindex-16 scores among patients with acne receiving isotretinoin treatment. Journal of the American Medical Association dermatology. 2020.156(10):1098-1106. DOI: 10.1001/jamadermatol.2020.2330

23. Wala K, Szepietowski JC. Difelikefalin in the Treatment of Chronic Kidney Disease-Associated Pruritus: A Systematic Review. Pharmaceuticals. 2022.15(8):934. DOI: 10.3390/ph15080934

24. Narita I, Tsubakihara Y, Uchiyama T et al. Efficacy and safety of difelikefalin in japanese patients with moderate to severe pruritus receiving hemodialysis: a randomized clinical trial. Journal of the American Medical Association Network Open. 2022.5(5):e2210339. DOI: 10.1001/jamanetworkopen.2022.10339

25. Volkov MM, Dobronravov VA. Uremic pruritus in patients on renal replacing therapy. Nephrology. 2006;10(2):110-117. ISSN: 1561-6274 (In Russian)

26. Minato S, Hirai K, Morino J et al. Factors Associated with Uremic Pruritus in Patients Undergoing Peritoneal Dialysis. Int J Nephrol Renovasc Dis. 2020;13:1-9. DOI: 10.2147/IJNRD.S224871

27. Szepietowski JC, Reich A, Schwartz RA. Uraemic xerosis. Nephrol Dial Transplant. 2004;19(11):2709-2712. DOI: 10.1093/ndt/gfh480

28. Attia EA, Hassan SI, Youssef NM. Cutaneous disorders in uremic patients on hemodialysis: an Egyptian case-controlled study. Int J Dermatol. 2010;49(9):1024-1030. DOI: 10.1111/j.1365-4632.2010.04466.x

29. Sukul N, Zhao J, Pisoni RL et al. Pruritus in Hemodialysis Patients: Longitudinal Associations With Clinical and Patient-Reported Outcomes. Am J Kidney Dis. 2023;82(6):666-676. DOI: 10.1053/j.ajkd.2023.04.008

30. Fontao SM, Manso P, Audije-Gil J et al. Quality of life and clinical data in hemodialysis patients with different degrees of pruritus. Scientific reports. 2025;15(1):6222. DOI: 10.1038/s41598-024-83833-2

31. E. Kelepouris, C. M. Rhee. CKD-Associated Pruritus: A Patient-Centered Approach to Reduce Symptom Burden. Kidney Medicine, 2025,7 (12). 101150.

32. Plewig N, Ofenloch R, Mettang T, Weisshaar E. The course of chronic itch in hemodialysis patients: results of a 4-year follow-up study of GEHIS (German Epidemiological Hemodialysis Itch Study). J Eur Acad Dermatol Venereol. 2019;33(7):1429-1435. DOI: 10.1111/jdv.15483

33. Mistik S, Utas S, Ferahbas A et al. An epidemiology study of patients with uremic pruritus. J Eur Acad Dermatol Venereol. 2006;20(6):672-678. DOI: 10.1111/j.1468-3083.2006.01570.x

34. Pisoni RL, Wikström B, Elder SJ et al. Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2006;21(12):3495-3505. DOI: 10.1093/ndt/gfl461

35. Engler F, Kerschbaum J, Keller F, Mayer G. Austrian Dialysis and Transplant Registry collaborators. Prevalence, patient burden and physicians' perception of pruritus in haemodialysis patients. Nephrol Dial Transplant. 2024;39(2):277-285. DOI: 10.1093/ndt/gfad152

36. Orasan OH, Saplontai AP, Cozma A et al. Insomnia, muscular cramps and pruritus have low intensity in hemodialysis patients with good dialysis efficiency, low inflammation and arteriovenous fistula. Int Urol Nephrol. 2017;49(9):1673-1679. DOI: 10.1007/s11255-017-1624-9

37. Ko MJ, Wu HY, Chen HY et al. Uremic pruritus, dialysis adequacy, and metabolic profiles in hemodialysis patients: a prospective 5-year cohort study. PLoS One. 2013;8(8):e71404. DOI: 10.1371/journal.pone.0071404

38. Kimmel M, Alscher DM, Dunst R et al. The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients. Nephrol Dial Transplant. 2006;21(3):749-755. DOI: 10.1093/ndt/gfi204