Prevalence and Outcomes of Chronic Kidney Disease-Associated Pruritus
Bibliographic record
Abstract
Key Points CKD-associated pruritus is highly prevalent among peritoneal dialysis patients. Pruritus is associated with reduced health-related quality of life, and the composite of mortality and transfer to hemodialysis for peritoneal dialysis patients. Efforts to better identify and manage pruritus in this population are needed. Background Pruritus is common in hemodialysis patients. Less is known about the prevalence and outcomes of pruritus among patients receiving peritoneal dialysis (PD). Herein, we describe the prevalence of pruritus and its associations with patient-reported outcomes (PROs) and mortality/transfer to hemodialysis. Methods We analyzed a multicenter, international cohort of PD patients enrolled in the PD Outcomes and Practice Patterns Study from 2014 to 2022. Pruritus was assessed at entry into the PD Outcomes and Practice Patterns Study with a single-question Likert Scale capturing the extent to which patients were bothered by itch ranging from 1: not at all to 5: extremely . The kidney disease quality of life-36 and the Center for Epidemiological Studies Depression Scale assessed various PROs. Moderate-to-extreme pruritus was defined as a Likert scale score ≥3. The associations of pruritus with PROs were assessed using linear/logistic regression where appropriate. Death or hemodialysis transfer was assessed using multivariable Cox regression models. Results Overall, 5535 patients from eight countries were included; 43% had moderate-to-extreme pruritus which was the highest in Thailand (50%) and the lowest in the United States (33%). The adjusted odds ratios of moderate-to-extreme pruritus were higher for diabetes, low albumin, and elevated phosphorus but lower for residual urine volume (adjusted odds ratio, 0.98 per 200 ml increase in 24-hour urine volume; 95% confidence interval, 0.96 to 1.00; P = 0.05). Patients with extreme pruritus had the lowest mental and physical health component scores and a higher burden of other PROs including restless legs and disturbed sleep. Overall, 921 patients died and 1150 were transferred to hemodialysis. Patients with moderate-to-extreme pruritus were at higher adjusted risk for death or hemodialysis transfer (adjusted hazard ratio, 1.12; 95% confidence interval, 1.02 to 1.23; P = 0.02) with similar point estimates for each subcomponent of the composite outcome. Conclusions Pruritus is highly prevalent in PD and associated with poor health outcomes. Efforts to better identify and manage pruritus should be considered in this population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".