Rayner HC, et al. - This study assessed the current international management of uremic pruritus in patients on hemodialysis, by determining the prevalence, awareness, and treatment of pruritus in such patients. A declining prevalence of pruritus was reported in people on hemodialysis, though it remained underestimated. No treatment was prescribed for large numbers of patients on hemodialysis with severe pruritus. In addition, the pattern of pruritus treatment with unlicensed medications varied widely.

Methods

• Researchers analyzed data from 35,452 patients on hemodialysis in up to 17 countries from the Dialysis Outcomes and Practice Patterns Study, in order to describe pruritus prevalence from 1996 to 2015.
• In addition, they analyzed data from 6256 patients and 268 medical directors in 17 countries in 2012–2015 to describe predictors, effects, medical directors’ awareness, and treatment of pruritus.

Results

• A decline was noted in the number of patients very much or extremely bothered by itching; from 28% in 1996 to 18% in 2015.
• Data reported that in 2012–2015, pruritus had a major effect on work and social life among patients nearly always or always bothered by itching; 18% used no treatment for pruritus, and 17% did not report itching to health care staff.
• Researchers found that overall 69% of medical directors underestimated the prevalence of pruritus in their unit.
• Managing high serum phosphorus and low Kt/V was ranked as the most important intervention, but findings indicated no link between these factors and pruritus; 57% of medical directors used oral antihistamines for first-line chronic treatment of pruritus.
• In addition, it was noted that 45% used gabapentin as first-, second-, or third-line treatment.
• Findings demonstrated that nalfurafine was only used in Japan.