慢性肾脏病相关瘙痒的患病率及结局：腹膜透析预后和实践模式研究（PDOPPS）的国际结果

Prevalence and Outcomes of Chronic Kidney Disease Associated Pruritus: International Results from PDOPPS.

作者信息

Tennankore Karthik K, McCullough Keith P, Bieber Brian, Cho Yeoungjee, Johnson David W, Kanjanabuch Talerngsak, Kawanishi Hideki, Kim Yong-Lim, Lambie Mark, Rigatto Claudio, Shen Jenny, Schreiber Martin, Perl Jeffrey, Pisoni Ronald L

机构信息

Consultant Nephrologist, Nova Scotia Health, Professor, Department of Medicine, Dalhousie University, 5820 University Avenue, Halifax, NS, B3H1V8.

Arbor Research Collaborative for Health, Ann Arbor, MI, USA.

出版信息

Clin J Am Soc Nephrol. 2024 Oct 11. doi: 10.2215/CJN.0000000000000537.

DOI:10.2215/CJN.0000000000000537

PMID:39392697

Abstract

BACKGROUND

Pruritus is common in hemodialysis (HD) patients. Less is known about the prevalence and outcomes of pruritus among patients receiving peritoneal dialysis (PD). Herein, we describe the prevalence of pruritus and its associations with patient-reported outcomes (PROs) and mortality/transfer to HD.

METHODS

We analyzed a multicenter, international cohort of PD patients enrolled in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) from 2014-2022. Pruritus was assessed at entry into PDOPPS with a single-question Likert Scale capturing the extent to which patients were bothered by itch ranging from 1: Not at all, to 5: Extremely. The KDQOL-36 and the Centre for Epidemiological Studies Depression Scale assessed various PROs. Moderate to extreme pruritus was defined as a Likert scale score ≥3. The associations of pruritus with PROs were assessed using linear/logistic regression where appropriate. Death or HD transfer was assessed using multivariable Cox regression models.

RESULTS

Overall, 5535 patients from seven countries were included; 43% had moderate to extreme pruritus which was highest in Thailand (50%) and lowest in the United States (33%). The adjusted odds ratios (aOR) of moderate to extreme pruritus were higher for diabetes, low albumin, and elevated phosphorus but lower for residual urine volume (aOR= 0.98 per 200 ml increase in 24-hour urine volume, 95% confidence interval [CI]; 0.96-1.00, P=0.05). Patients with extreme pruritus had the lowest mental and physical health component scores and a higher burden of other PROs including restless legs and disturbed sleep. Overall, 899 patients died and 1221 transferred to HD. Patients with moderate to extreme pruritus were at higher adjusted risk for death or HD transfer (adjusted hazard ratio [aHR] 1.12, 95% CI 1.02-1.23, P=0.02) with similar point estimates for each subcomponent of the composite outcome.

CONCLUSIONS

Pruritus is highly prevalent in PD and associated with poor health outcomes. Efforts to better identify and manage pruritus should be considered in this population.

摘要

背景

瘙痒在血液透析（HD）患者中很常见。对于接受腹膜透析（PD）的患者，瘙痒的患病率及相关结果了解较少。在此，我们描述了瘙痒的患病率及其与患者报告结局（PROs）以及死亡率/转为血液透析的相关性。

方法

我们分析了2014年至2022年纳入腹膜透析结局和实践模式研究（PDOPPS）的一个多中心国际腹膜透析患者队列。在进入PDOPPS时，使用一个单问题李克特量表评估瘙痒情况，该量表记录患者受瘙痒困扰的程度，范围从1：完全没有，到5：极其严重。KDQOL - 36和流行病学研究中心抑郁量表评估了各种PROs。中度至重度瘙痒定义为李克特量表评分≥3。在适当情况下，使用线性/逻辑回归评估瘙痒与PROs的相关性。使用多变量Cox回归模型评估死亡或转为血液透析情况。

结果

总体而言，纳入了来自七个国家的5535名患者；43%的患者有中度至重度瘙痒，其中泰国最高（50%），美国最低（33%）。糖尿病、低白蛋白和高磷患者出现中度至重度瘙痒的调整后比值比（aOR）较高，但残余尿量与中度至重度瘙痒的调整后比值比（aOR）较低（每24小时尿量增加200 ml，aOR = 0.98，95%置信区间[CI]；0.96 - 1.00，P = 0.05）。有重度瘙痒的患者心理健康和身体健康成分得分最低，并且包括不安腿和睡眠障碍在内的其他PROs负担更高。总体而言，899名患者死亡，1221名患者转为血液透析。中度至重度瘙痒患者死亡或转为血液透析的调整后风险更高（调整后风险比[aHR] 1.12，95% CI 1.02 - 1.23，P = 0.02），复合结局各亚组的点估计值相似。