Poku Edith, Harnan Sue, Rooney Gill, James Marrissa Martyn-St, Hernández-Alava Mónica, Schaufler Thilo, Thokala Praveen, Fotheringham James
School of Health and Related Research, University of Sheffield, UK.
Vifor Pharma Ltd., Glattbrugg, Switzerland.
Clin Kidney J. 2021 Nov 9;15(3):484-499. doi: 10.1093/ckj/sfab218. eCollection 2022 Mar.
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.
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.
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.
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).
慢性肾脏病相关性瘙痒（CKD-aP）是终末期肾病（ESKD）患者常见且负担沉重的病症，尤其是接受血液透析的患者。因此，CKD-aP与健康相关生活质量（HRQoL）之间关系的高质量证据可为临床医生和政策制定者提供治疗选择和报销决策的依据。
进行了一项系统的文献综述和叙述性综合分析，按研究设计和HRQoL工具进行分层，以评估接受中心血液透析的成年ESKD患者中，CKD-aP与使用多维通用或特定疾病偏好或非偏好性测量方法评估的HRQoL之间的关系。检索了从创刊至2020年3月的MEDLINE、Embase、科学网、生物学文摘索引、Cochrane图书馆和PsycINFO，两名审稿人独立提取数据。
检索到2684条独特记录，其中纳入了20篇与18项独特研究相关的论文[5项随机对照试验（RCT）和13项观察性研究]。使用四种通用测量方法和八种疾病特异性测量方法评估HRQoL。通过均值比较、线性回归和相关性分析评估CKD-aP的影响。采用全面调整多变量线性回归的观察性研究大多发现CKD-aP严重程度与HRQoL之间存在关联。分析表明，这种关系部分由CKD-aP引起的睡眠障碍介导。显示CKD-aP严重程度改善的RCT与HRQoL的临床意义改善相关。与通用测量方法相比，疾病特异性HRQoL工具报告随着CKD-aP减轻有更大变化。研究设计和报告的异质性排除了进行荟萃分析的可能性。
在大多数观察性和RCT研究中，发现CKD-aP严重程度与HRQoL恶化相关。干预措施使CKD-aP和HRQoL同时改善可能支持其应用（PROSPERO注册号175035）。
