Prevalence and Severity of Pruritus in Patients on Hemodialysis: A Cross-Sectional Study
Notice bibliographique
Résumé
Background: Chronic kidney disease-associated pruritus (CKD-aP) is a distressing symptom associated with dialysis that negatively affects quality of life. Chronic kidney disease-associated pruritus is under-recognized due to a lack of clinical attention and symptom screening. Objective: Assess the prevalence and severity of CKD-aP in a regional hemodialysis program. Design: Cross-sectional study. Setting and Patients: All outpatients receiving in-center hemodialysis at the Kingston Health Sciences Centre. Measurements: Patients were asked to complete the Worst Itching Intensity Numerical Scale (WI-NRS), with moderate-to-severe pruritus classified as a score greater than 4, and the Self-Assessed Disease Severity (SADS) scale. Demographic, laboratory, and prescription data were extracted from patient medical records and patients were asked to self-report over-the-counter pruritus medications. Methods: Comparative differences in demographics and laboratory values at the time of determining the WI-NRS and SADS were analyzed using a Fisher’s exact test with Bonferroni correction for categorical variables and the Mann-Whitney U test for continuous variables. Correlations between select variables and the WI-NRS score were assessed using linear regression analyses. Adjusted associations with moderate-to-severe CKD-aP were examined using odds ratios with corresponding 95% confidence intervals. Results: A total of 307 patients completed the WI-NRS and 302 completed the SADS. Fifty-seven percent of patients reported some degree of CKD-aP, 31% of patients had moderate-to-severe CKD-aP, and 9% reported interference with quality of life (patients in SADS group C). Patients with moderate-to-severe CKD-aP and those significantly affected by CKD-aP (patients in SADS group C) were more likely to use over-the-counter treatments than patients with mild or no CKD-aP ( P < .0001) and patients in SADS group A ( P < .0001), respectively. Of patients with moderate-to-severe CKD-aP and whose CKD-aP significantly affected their quality of life (patients in SADS group C), 42% and 11.11%, respectively, did not use any form of treatments. Patients with moderate-to-severe CKD-aP had significantly higher parathyroid hormone (PTH; 0.02) and phosphate ( P = .01). A higher body mass index (BMI) was associated with a greater WI-NRS score ( R 2 = 0.030, P = .003). Of patients with moderate-to-severe CKD-aP, 24% reported significant debilitation (patients in SADS group C). Finally, adjusted associations were found between moderate-to-severe CKD-aP and the following variables: BMI (OR = 1.05, 95% CI = 1.01-1.09, P = .02); serum phosphate (OR = 2.12, 95% CI = 1.15-4.00, P = .02); being a current smoker (OR = 0.46, 95% CI = 0.20-0.95, P = .04); and a serum phosphate greater than or equal to 1.8 mmol/L (OR = 2.33, 95% CI = 1.29-4.26, P = .01). Limitations: There were some missing data points in patient records and patients’ reports of over-the-counter medications. We could not assess whether patients actually had CKD-aP, or pruritus due to other causes. Treatment adherence could not be measured as well as whether treatments were specifically prescribed for CKD-aP. Moreover, our electronic medical record system could not capture prescribed topicals or pruritus-related medical conditions. Finally, this study did not assess physician’s awareness of CKD-aP. Conclusions: A substantial proportion of patients with moderate-to-severe CKD-aP reported a significant impact on quality of life. Elevated PTH, phosphate, and BMI were associated with CKD-aP. In addition, almost half of patients with moderate-to-severe CKD-aP did not use any treatments. There exist gaps and opportunities for care for patients with CKD-aP. Increased clinical attention to CKD-aP could identify those who may benefit from care interventions that improve quality of life.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».