Guedes Murilo, Tu Charlotte, Sukul Nidhi, Asgari Elham, Guebre-Egziabher Fitsum, Ruessmann Despina, Schaufler Thilo, Rayner Hugh, Jadoul Michel, Labriola Laura, Pecoits-Filho Roberto, Pisoni Ronald L, Karaboyas Angelo
Arbor Research Collaborative for Health, Ann Arbor, USA.
Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
Clin Kidney J. 2024 Sep 4;17(10):sfae276. doi: 10.1093/ckj/sfae276. eCollection 2024 Oct.
The associations between self-reported chronic kidney disease-associated pruritus (CKD-aP) and patient-reported outcomes (PROs) have been reported using various instruments to assess itch. Data collection via multiple CKD-aP instruments allows the evaluation of different domains and measurements of CKD-aP burden and may help tailor data capture for future research or clinical care.
An electronic PRO (ePRO) survey was distributed to European hemodialysis (HD) patients enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) in 2021-23. The DOPPS is an international cohort study that aims to investigate practice patterns and outcomes in HD patients. The ePRO survey included multiple CKD-aP instruments: Average Itch and Worst Itching Intensity Numerical Rating Scales (AI-NRS, WI-NRS) and a Kidney Disease Quality of Life (KDQOL)-36 single question. Linear and logistic regression were used to estimate adjusted associations between CKD-aP instruments and various PROs.
This analysis included 769 patients who completed the WI-NRS from HD facilities in France, Germany, Italy, Spain, Sweden and the UK. The correlation between WI-NRS and the KDQOL-36 itch question was 0.88 overall and 0.46 among patients at least somewhat bothered by itch. Mean WI-NRS scores stratified by response to the KDQOL-36 itch question were 8.1, 6.4, 4.1 and 3.1 for extremely, very much, moderately and somewhat bothered, respectively. Patients with worse WI-NRS scores reported worse sleep quality, greater fatigue, more depressive symptoms, and lower mental and physical quality of life; these associations were similar to those observed for the KDQOL-36 itch question.
Correlation between CKD-aP instruments was high overall, but moderate among the subgroup of patients bothered by itch; differences can be partially attributed to the recall period for the KDQOL-36 (4 weeks) vs the AI- and WI-NRS (24 h). The consistent associations of these instruments with poor outcomes underscores the importance to identify and effectively treat HD patients suffering from pruritus.
使用各种工具评估瘙痒后，已报告了自我报告的慢性肾脏病相关性瘙痒（CKD-aP）与患者报告结局（PROs）之间的关联。通过多种CKD-aP工具收集数据，可以评估CKD-aP负担的不同领域和测量指标，并可能有助于为未来的研究或临床护理量身定制数据收集。
2021年至2023年，向参与透析结局和实践模式研究（DOPPS）的欧洲血液透析（HD）患者发放了一份电子PRO（ePRO）调查问卷。DOPPS是一项国际队列研究，旨在调查HD患者的实践模式和结局。ePRO调查问卷包括多种CKD-aP工具：平均瘙痒和最严重瘙痒强度数字评定量表（AI-NRS、WI-NRS）以及肾脏病生活质量（KDQOL）-36单项问题。采用线性和逻辑回归来估计CKD-aP工具与各种PROs之间的校正关联。
该分析纳入了769名来自法国、德国、意大利、西班牙、瑞典和英国HD机构并完成WI-NRS的患者。WI-NRS与KDQOL-36瘙痒问题之间的总体相关性为0.88，在至少有点受瘙痒困扰的患者中为0.46。根据对KDQOL-36瘙痒问题的回答分层的平均WI-NRS评分，对于极度困扰（extremely）、非常困扰（very much）、中度困扰（moderately）和有点困扰（somewhat）的患者，分别为8.1、6.4、4.1和3.1。WI-NRS评分较差的患者报告睡眠质量较差、疲劳感更强、抑郁症状更多，以及心理和生理生活质量更低；这些关联与KDQOL-36瘙痒问题所观察到的关联相似。
总体而言，CKD-aP工具之间的相关性较高，但在受瘙痒困扰的患者亚组中为中度；差异可部分归因于KDQOL-36（4周）与AI-NRS和WI-NRS（24小时）的回忆期。这些工具与不良结局的一致关联强调了识别和有效治疗患有瘙痒的HD患者的重要性。
