Profile of Chronic Kidney Disease–Associated Pruritus in Patients on Maintenance Hemodialysis: A Cross-Sectional Study from a Hub-and-Spoke Dialysis Network

Abstract

Background: Chronic kidney disease–associated pruritus (CKD-aP) is a clinically important but frequently under-recognised symptom in patients receiving maintenance haemodialysis. Data from large government-sector hub-and-spoke dialysis networks in India remain limited. Aims: To determine the prevalence and clinical characteristics of chronic kidney disease–associated pruritus (CKD-aP) among patients on maintenance haemodialysis (MHD) in a hub-and-spoke dialysis network. Study Design: Cross-sectional observational study. Place and Duration of Study: Department of Nephrology, Gandhi Medical College and Hospital (hub) and affiliated spoke dialysis centres, Telangana, India. Methodology: Adult patients (>18 years) on MHD at the spoke centres of this hub-and-spoke network were screened and asked to complete a structured questionnaire assessing the presence, frequency, severity, and impact of pruritus. Itch intensity was graded using the Numerical Rating Scale (NRS; mild 1–3, moderate 4–6, severe 7–10) and the Five-Dimensional (5-D) Itch Scale. Demographic, dialysis-related, and laboratory parameters were recorded. Categorical variables were compared using Pearson's chi-square test, and continuous variables between patients with and without pruritus were compared using Welch's independent-samples t-test; P < .05 was considered statistically significant. Results: Of the 806 adult patients on MHD who were screened, 163 (20.2%) reported pruritus. Pruritus was associated with longer dialysis vintage (>3 years: 35.0% vs 21.9%; P = .002) and diabetes mellitus (31.3% vs 23.8%; P = .049). Compared with patients without pruritus, those with pruritus had higher serum creatinine (P = .002), lower serum albumin (P = .002), lower serum calcium (P = .005), higher serum phosphorus (P = .003), lower serum uric acid (P = .022), and higher parathyroid hormone (P = .030). Age, sex, haemodialysis frequency, vascular access type, and haemoglobin did not differ significantly. Most affected patients had mild pruritus by NRS (71.2%), 23.9% had moderate pruritus, and 4.9% had severe pruritus. The lower limbs (73.6%) and back (39.9%) were the most commonly affected sites. Conclusion: Approximately one in five patients on MHD in this hub-and-spoke network experienced CKD-aP. Longer dialysis vintage, diabetes mellitus, and several laboratory differences were associated with CKD-aP in unadjusted analyses. Routine screening with simple, validated tools such as the NRS and 5-D Itch Scale may facilitate earlier identification and symptom-directed management in similar dialysis settings.