Department of Internal Medicine, Division of Nephrology and.
Centre for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris Sud, Université Versailles Saint Quentin, UMRS 1018, Villejuif, France.
Clin J Am Soc Nephrol. 2019 May 7;14(5):673-681. doi: 10.2215/CJN.09600818. Epub 2019 Apr 11.
Among patients on hemodialysis, pruritus has been associated with poorer mental and physical quality of life, sleep quality, depression, and mortality. We evaluated patients with nondialysis CKD to describe the prevalence of pruritus, identify associated factors, and investigate associations with patient-reported outcomes.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using cross-sectional data from patient questionnaires in the CKD Outcomes and Practice Patterns Study (CKDopps), we asked patients with CKD stages 3-5 (nondialysis) from the United States, Brazil, and France to identify how much they were bothered by pruritus. Response options ranged from "not at all" to "extremely." Log-Poisson regression, yielding prevalence ratios, was used to evaluate associations of moderate-to-extreme pruritus with patient characteristics, CKD stage, self-reported depression symptoms, and restless sleep. Mixed linear regression was used to examine associations between pruritus and physical and mental component summary scores, with lower scores indicating poorer quality of life.
Of the 5658 CKDopps patients enrolled in the United States, Brazil, and France, 3780 (67%) answered the pruritus question. The prevalence of moderate-to-extreme pruritus was 24%, and more likely in older patients, women, and those with stage 5 CKD, lung disease, diabetes, and physician-diagnosed depression. In adjusted models, patients with moderate pruritus had physical and mental component summary scores 3.5 (95% confidence interval [95% CI], -4.6 to -2.3) and 2.3 (95% CI, -3.2 to -1.5) points lower, respectively, than patients without pruritus, and they also had a higher adjusted prevalence of patient-reported depression (prevalence ratio, 1.83; 95% CI, 1.58 to 2.11) and restless sleep (prevalence ratio, 1.69; 95% CI, 1.49 to 1.91) compared with patients without pruritus. These patient-reported outcomes were progressively worse with increasing severity of pruritus.
Our findings demonstrate high prevalence of pruritus in nondialysis CKD, as well as strong associations of pruritus with poor health-related quality of life, self-reported depression symptoms, and self-reported poor sleep.
在接受血液透析的患者中，瘙痒与较差的身心生活质量、睡眠质量、抑郁和死亡率有关。我们评估了非透析慢性肾脏病（CKD）患者，以描述瘙痒的患病率，确定相关因素，并探讨与患者报告的结局的关系。
设计、设置、参与者和测量：使用美国、巴西和法国 CKD 结局和实践模式研究（CKDopps）患者问卷的横断面数据，我们要求 CKD 3-5 期（非透析）患者（n=5658）识别他们的瘙痒程度。答案选项范围从“一点也不”到“非常”。使用对数泊松回归（产生患病率比）来评估中重度瘙痒与患者特征、CKD 分期、自我报告的抑郁症状和不安睡眠之间的关系。混合线性回归用于检查瘙痒与身体和精神成分综合评分之间的关系，较低的分数表明生活质量较差。
在纳入美国、巴西和法国的 5658 名 CKDopps 患者中，有 3780 名（67%）回答了瘙痒问题。中重度瘙痒的患病率为 24%，在年龄较大的患者、女性和患有 5 期 CKD、肺部疾病、糖尿病和医生诊断的抑郁症的患者中更常见。在调整后的模型中，中度瘙痒患者的身体和精神成分综合评分分别低 3.5（95%置信区间[95%CI]，-4.6 至-2.3）和 2.3（95%CI，-3.2 至-1.5）分，与无瘙痒的患者相比，他们的抑郁症状（患病率比，1.83；95%CI，1.58 至 2.11）和不安睡眠（患病率比，1.69；95%CI，1.49 至 1.91）的调整后患病率也更高。与无瘙痒的患者相比，这些患者报告的结果随着瘙痒的严重程度增加而逐渐恶化。
我们的研究结果表明，非透析性 CKD 瘙痒的患病率很高，瘙痒与较差的健康相关生活质量、自我报告的抑郁症状和自我报告的睡眠质量差密切相关。
