Introduction and Aims: Uraemic pruritus (UP) in haemodialysis (HD) patients is common and associated with reduced quality of life and increased mortality. As a benchmark for improvement, we describe the prevalence, awareness and treatment of UP for HD patients in 17 countries in the DOPPS.
Methods: Data were taken from DOPPS phase 1-5 (1996-2015). Data in phase 5 (2012-2015) were from 5713 patient questionnaires and 268 medical director surveys from HD facilities in Belgium, Canada, the 6 Gulf Cooperation Council countries, Germany, Italy, Japan, Russia, Spain, Sweden, Turkey, UK and USA.
Results: Overall, HD patients moderately to extremely bothered by itchy skin declined from 44% in 1996-2001 to 37% in 2012-15. 9 countries with continuous data from 2002 showed the same trend. In 2012-15 this varied from 25% in Germany to 52% in the UK (figure).
Nephrologists appear to significantly underestimate the prevalence of UP. On average, 20.5% of patients in each country who were at least moderately bothered by itchy skin did not report their symptoms to a healthcare professional. Severe UP was undertreated; 20.3% of patients who were very much or extremely bothered by itchy skin used no treatment for it. For patients with severe UP, phosphorus control in patients with high serum phosphorus was ranked as the most important therapeutic option by nephrologists. The most commonly used medications were oral and topical antihistamines. UVB phototherapy was rarely used. Overall, a majority of nephrologists never used gabapentin or pregabalin. However, in Germany, which has the lowest prevalence of severe UP, all dialysis facility medical directors reported using gabapentin as chronic therapy.
Conclusions: There is a major opportunity to improve the health and wellbeing of HD patients through increased attention to the burden of uraemic pruritus and greater use of effective treatments.
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