The relationship between chronic kidney disease-associated pruritus and health-related quality of life: a systematic review

Edith Poku; Sue Harnan; Gill Rooney; Marrissa Martyn-St James; Mónica Hernández-Alava; Thilo Schaufler; Praveen Thokala; James Fotheringham

doi:10.1093/ckj/sfab218

The relationship between chronic kidney disease-associated pruritus and health-related quality of life: a systematic review

Clin Kidney J. 2021 Nov 9;15(3):484-499. doi: 10.1093/ckj/sfab218. eCollection 2022 Mar.

Authors

Edith Poku¹, Sue Harnan¹, Gill Rooney¹, Marrissa Martyn-St James¹, Mónica Hernández-Alava¹, Thilo Schaufler², Praveen Thokala¹, James Fotheringham¹

Affiliations

¹ School of Health and Related Research, University of Sheffield, UK.
² Vifor Pharma Ltd., Glattbrugg, Switzerland.

Abstract

Background: Chronic kidney disease-associated pruritus (CKD-aP) is a common and burdensome condition for end-stage kidney disease (ESKD) patients, especially those receiving haemodialysis. High-quality evidence of the relationship between CKD-aP and health-related quality of life (HRQoL) can therefore inform clinicians and policymakers about treatment choice and reimbursement decisions.

Methods: A systematic literature review and narrative synthesis stratified by study design and HRQoL instrument was conducted to evaluate in adult ESKD patients receiving in-centre haemodialysis the relationship between CKD-aP and HRQoL assessed using multi dimensional generic or condition-specific preference- or non-preference-based measures. MEDLINE, Embase, Web of Science, BIOSIS Citation Index, Cochrane Library and PsycINFO from inception to March 2020 were searched, with two reviewers extracting data independently.

Results: Searches identified 2684 unique records, of which 20 papers relating to 18 unique studies [5 randomised controlled trials (RCTs) and 13 observational studies] were included. HRQoL was assessed using four generic and eight disease-specific measures. The impact of CKD-aP was assessed by comparison of means, linear regression and correlation. Observational studies employing comprehensively adjusted multivariable linear regression largely found associations between CKD-aP severities and HRQoL. Analyses suggest this relationship is partially mediated by the sleep disturbance caused by CKD-aP. RCTs showing improvements in CKD-aP severity were associated with clinically meaningful improvements in HRQoL. Compared with generic measures, disease-specific HRQoL instruments reported greater changes with reduced CKD-aP. Heterogeneity in study design and reporting precluded meta-analysis.

Conclusions: CKD-aP severity was found to be associated with a worsening of HRQoL in the majority of observational and RCT studies. Parallel improvements in CKD-aP and HRQoL with interventions may support their use (PROSPERO registration 175035).

Keywords: haemodialysis; itch; pruritus; quality of life; systematic review.