Chronic Kidney Disease-Associated Pruritus in Danish Dialysis Patients: A Cross-Sectional Multicenter Study of Prevalence, Disease Burden, and Current Treatment Practices

Rationale & Objective Chronic kidney disease-associated pruritus (CKD-aP) is rarely systematically assessed despite the potential negative impact on quality of life (QoL). This study investigated prevalence, disease burden, physician awareness, and treatment practices. Study Design Multicenter cross-sectional study using patient-reported outcome measures (PROMs) and a physician practice survey. Setting & Population Adult patients with chronic kidney failure requiring replacement therapy (KFRT) and nephrologists from 8 Danish hospitals. Exposure KFRT and dialysis modality. Outcomes CKD-aP prevalence (score >4) and pruritus severity (range 0-10) according to the worst itch numeric rating scale (WI-NRS). QoL and skin distribution assessed with the 5-D itch scale (range 5-25). Physician awareness and treatment practices (self-invented questionnaire). Analytical Approach Descriptive statistics were used. Results We recruited 642 patients (∼25% of the Danish dialysis population): 83% on hemodialysis (HD), 13% on peritoneal dialysis (PD), and 4% on home HD (HHD). Median WI-NRS score (IQR) was 0(0-4). CKD-aP prevalence (95% CI) was 21(18-24)% (WI-NRS >4). Moderate to very severe pruritus (WI-NRS ≥4) was found in 25(19-32)%. Median 5-D score (IQR) was 5(5-10) (all patients). PD patients had significantly higher WI-NRS and 5-D score than HD and HHD patients. Overall, the impact of CKD-aP on daily activities was minimal but sleep disability (score >1) was found in 20%. Sleep disability correlated significantly with higher WI-NRS score. Based on 75 questionnaires (nephrologists/residents: 46/25) most physicians overestimated CKD-aP prevalence and favored dialysis, fatty cream and phosphate-lowering treatment rather than systemic treatment with gabapentinoids or difelikefalin. Limitations Single-time-point estimate of CKD-aP and few HHD patients. No dermatologic evaluation was performed to exclude other pruritic conditions. Conclusions About 1/5 to 1/4 of dialysis patients have CKD-aP, which mainly impairs QoL via sleep disturbance. Physicians demonstrated adequate awareness, but treatment remained largely limited to dialysis and fatty cream. Simple PROMs facilitate systematic assessment.