Abstract: TH-PO243
Pruritus and Mortality in Hemodialysis Patients: Results from the International DOPPS
Session Information
- Hemodialysis and Frequent Dialysis - II
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Sukul, Nidhi, University of Michigan, Ann Arbor, Michigan, United States
- Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Rayner, Hugh C., Heart of England NHS Foundation Trust, Birmingham, WEST MIDLANDS, United Kingdom
- Urena Torres, Pablo A., Department of Dialysis, AURA Nord Saint Ouen and Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France
- Csomor, Philipp, Vifor Fresenius Medical Care Renal Pharma Ltd., Glattbrugg, Switzerland
- Schaufler, Thilo, Vifor Pharma Management Ltd., Glattbrugg, Switzerland
- Wen, Warren, Cara Therapeutics, Stamford, Connecticut, United States
- Menzaghi, Frederique, Cara Therapeutics, Inc., Stamford, Connecticut, United States
- Hasegawa, Takeshi, Showa University, Yokohama, kanagawa, Japan
- Chen, Yuqing, Peking University First Hospital, Beijing, China
- Al Salmi, Issa, The Royal Hospital, Muscat, Oman
- Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background
Chronic kidney disease-associated pruritus (CKD-aP) has been previously associated with poorer quality-of-life and increased risk of depression and death in hemodialysis (HD) patients. We sought to assess the association between pruritus and mortality in a large, contemporary, international cohort of HD patients.
Methods
We analyzed 25,916 HD patients from 21 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4-6 (2009-2018) who self-reported the degree to which they were bothered by itchy skin (5-category ordinal scale from “Not at all” to “Extremely”). We used Cox regression to investigate the association between pruritus and all-cause mortality, adjusted for confounders.
Results
The proportion of patients who were at least moderately bothered by pruritus was 37% overall, and ranged from 27% in Germany to 47% in the UK. The groups with more severe pruritus had lower mean hemoglobin and albumin, a higher proportion of catheter use, and a higher prevalence of cardiovascular comorbidities, diabetes, and psychiatric disorders. The death rate was 0.106/year over a median (IQR) follow-up of 17 (9, 27) months (4,063 deaths). Compared to the reference group of patients not at all bothered by itching, the adjusted mortality HR (95% CI) was 1.02 (0.93, 1.11) for somewhat bothered, 1.13 (1.03, 1.24) for moderately bothered, 1.08 (0.98, 1.21) for very much bothered, and 1.30 (1.15, 1.48) for extremely bothered (Figure).
Conclusion
Analyzing these recent data, survival was shorter for HD patients who were moderately-to-extremely affected by pruritus. These results underscore the importance of diagnosing, evaluating possible causes of, and treating CKD-aP, with the goal of reducing symptom severity, in hopes of improving patient outcomes.
Funding
- NIDDK Support – This analysis was supported by Vifor, Relypsa, and Cara Therapeutics. The DOPPS Program is supported by Amgen (since 1996, founding sponsor), Kyowa Hakko Kirin (since 1999 for Japan DOPPS), and Baxter Healthcare Corp. Additional support for specific projects and countries is provided by Akebia Therapeutics, AstraZeneca, European Renal Association-European Dialysis & Transplant Association (ERA-EDTA), Fibrogen, Fresenius Medical Care Asia-Pacific Ltd, Fresenius Medical Care Canada Ltd, German Society of Nephrology (DGfN), Italian Society of Nephrology (SIN), Janssen, Japanese Society for Peritoneal Dialysis (JSPD), Kidney Care UK, MEDICE Arzneimittel Pütter GmbH & Co KG, Otsuka America, Proteon Therapeutics, the Association of German Nephrology Centres, and Vifor Fresenius Medical Care Renal Pharma. Public funding and support is provided for specific DOPPS projects, ancillary studies, or affiliated research projects by National Health & Medical Research Council (NHMRC) in Australia, Belgian Federal Public Service of Public Health in Belgium, Cancer Care Ontario (CCO) through the Ontario Renal Network (ORN) in Canada, French National Institute of Health and Medical Research (INSERM) in France, Thailand Research Foundation (TRF), Chulalongkorn University Matching Fund, King Chulalongkorn Memorial Hospital Matching Fund, and the National Research Council of Thailand (NRCT) in Thailand, National Institute for Health Research (NIHR) via the Comprehensive Clinical Research Network (CCRN), and Kidney Research UK (KRUK) in the United Kingdom, and the Agency for Healthcare Research and Quality (AHRQ) and National Institutes of Health (NIH) in the US. All support is provided without restrictions on publications. All grants are made to Arbor Research Collaborative for Health.