Assessing Response to Difelikefalin in Adults Receiving Haemodialysis: A Multidisciplinary, Person‐Centred Framework for Chronic Kidney Disease‐Associated Pruritus

BACKGROUND: Chronic kidney disease-associated pruritus remains under-recognised in adults receiving haemodialysis and is associated with impaired sleep, quality of life and daily functioning. Translating treatment effects into consistent routine monitoring remains challenging. OBJECTIVES: To synthesise evidence relevant to multidimensional assessment of response to difelikefalin and propose a practical, person-centred framework for haemodialysis care. DESIGN: State-of-the-art narrative review informed by a structured pragmatic literature search. PARTICIPANTS: Not applicable. MEASUREMENTS: Evidence was synthesised across itch intensity, sleep-related disruption, pruritus-related quality of life, wider symptom burden, patient-reported outcome measures, implementation in kidney care and exploratory biomarkers. RESULTS: Evidence supports improvements with difelikefalin in itch intensity, sleep-related disruption and pruritus-related quality of life. We propose a brief core set combining the Worst Itching Intensity Numerical Rating Scale with sleep and daily-burden questions, supplemented by Skindex-10 and 5-D Itch when indicated. The combined set, brief burden questions and within-session assessment timing are unvalidated implementation proposals. Full response, partial response and persistent burden are pragmatic communication labels, not validated phenotypes. Reviews around Weeks 4 and 12 are informed by trial assessment points; subsequent 8- to 12-week intervals are pragmatic and unvalidated. Established instrument thresholds support interpretation of change, while exploratory biomarkers remain research-only. CONCLUSIONS: The proposed person-centred framework may support multidimensional assessment of difelikefalin response. Its feasibility, response categories and clinical utility require prospective validation before it can be considered a validated clinical pathway.