Prevalence and Severity of Pruritus in Patients on Hemodialysis: A Cross-Sectional Study
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".