Chronic kidney disease-associated pruritus and patient-centred outcomes: a systematic review

Background: Chronic kidney disease-associated pruritus (CKD-aP) is a debilitating symptom that can significantly impact patients’ daily activities and quality of life. This systematic review aimed to assimilate the latest evidence on the relationship between CKD-associated pruritis and patient-centred outcomes. Methods: A comprehensive search was conducted to identify relevant studies in PubMed, Medline and Embase via OVID, CINAHL, and Web of Science from 2000 to June 2024. Quality appraisal and subsequent data extraction were performed using the Joanna Briggs Institute (JBI) tools and a modified extraction form derived from JBI. Results: The review included 29 studies with a total of 147,174 CKD patients, including those on haemodialysis (HD) and peritoneal dialysis (PD). The most frequently reported patient-centred outcomes included quality of life (n = 21), sleep quality (n = 17), anxiety/depression (n = 11) and mortality (n = 7). There was a paucity of data on patients in the pre-dialysis stages, those undergoing PD, and following a conservative (non-dialytic) pathway. The impact of CKD-associated pruritus on outcomes was contingent on the severity of CKD-associated pruritus. There was an association between increased medication usage, decreased compliance with HD treatments and higher rates of hospitalisation in patients experiencing severe pruritus. Conclusion: Our review underscores the pernicious impact of CKD-associated pruritus on patient outcomes and emphasises the importance of effective management to improve patient-centred outcomes. Additional investigations are warranted among patients undergoing PD, those in pre-dialysis stages, and on conservative (non-dialytic) pathways, to achieve a more comprehensive understanding of the impact of CKD-associated pruritus in these patient groups.