Response of patients with hemodialysis-associated pruritus to new treatment algorithm with nalfurafine hydrochloride: a retrospective survey-based study

Pruritus in hemodialysis patients is a serious complication that lowers quality of life and adversely affects survival. Hemodialysis-associated pruritus has multiple causes and treatments; however, no effective treatment has been established and many cases are treatment-resistant. Nalfurafine hydrochloride, introduced in 2009 as a treatment for hemodialysis-associated pruritus, has been shown to alleviate itching in hemodialysis patients with existing therapy-resistant pruritus. Based on those reports, we reviewed our strategy for pruritus management in hemodialysis patients in June 2009 and established a new treatment algorithm, which included nalfurafine hydrochloride, modified drug therapy, and patient guidance on skin care and daily life. To evaluate the effectiveness of the new treatment algorithm, we conducted pre- and post-implementation surveys of 215 patients receiving maintenance hemodialysis. The first survey was performed in May 2009, before introduction of the algorithm, and the second in April 2013, 4 years after algorithm introduction. In both surveys, patients provided information about the presence of pruritus, its intensity, and their satisfaction with treatment. The percentage of patients with pruritus decreased significantly from 83.3 to 69.8 % following algorithm introduction, accompanied by a significant reduction in the percentage of patients reporting severe itching (from 13.0 to 2.8 %). Furthermore, the percentage of patients with pruritus-related insomnia decreased from 12.6 to 4.7 %. Patient satisfaction with treatment improved significantly from 49.1 to 70.6 %. When analysis was confined to patients receiving nalfurafine hydrochloride as a component of pruritus management, the percentage of patients complaining of severe itching decreased from 46.7 to 0 % after the start of treatment. Our findings suggest that pruritus in hemodialysis patients can be improved with the introduction of a team-based treatment algorithm, consisting of drug therapy (including nalfurafine treatment), skin care, and daily-life guidance.