CKD-Related Pruritus Risk Factors ID’d

OLDER AGE, higher body mass index (BMI), and current smoking are among the risk factors for moderate to severe pruritus in patients with nondialysis chronic kidney disease (CKD), according to investigators.

In a study of 1951 participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) study who did not have pruritus at baseline, moderate to severe pruritus — defined as a response of 3 or higher on a Likert scale of 1 to 5 — developed in 660 patients (34%) over a median follow-up duration of 6 years, Kendra Wulczyn, MD, of the nephrology division at Massachusetts General Hospital in Boston, and colleagues reported in the Clinical Journal of the American Society of Nephrology. Patients aged 65 years or older had a significant 31% increased risk for moderate to severe pruritus compared with those aged 44 to 64 years, according to the investigators. Each 5 kg/m2 increase in BMI was associated with a 10% increased risk. Current smokers had a 60% increased risk compared with patients who were not current smokers.

decreased by 14% and all-cause mortality by 13% with use of nonsteroidal MRAs, Dr Zhou’s team reported.

The investigators also found evidence that nonsteroidal MRAs reduce albuminuria. Compared with controls, patients taking nonsteroidal MRAs experienced a urinary albumin to creatinine ratio (UACR) decline of 32%, a 2.9-fold greater likelihood of a 30% or more decrease in UACR, or an absolute UACR reduction of 105.13 mg/g. Systolic blood pressure decreased by an additional 2.58 mm Hg and diastolic blood pressure by an additional 1.82 mm Hg with use of the nonsteroidal MRAs compared with control.

With respect to safety, the investigators found no significantly greater risks of hyperkalemia, elevated serum potassium, hypotension, hypoglycemia, or urinary tract infection with nonsteroidal MRAs.

The investigators judged the quality of the evidence to be low to moderate and encouraged more well-controlled trials. ■

Opioid use was associated with a 27% increased risk for moderate to severe pruritus compared with nonuse. Patients with moderate depressive symptoms had a 46% increased risk compared with those who had no depressive symptoms. An iPTH level of 65 pg/mL or higher was associated with a 30% increased risk compared with lower levels. Patients with a serum calcium level less than 9 mg/dL had a 20% decreased risk compared with those who had a level of 9.0-9.4 mg/dL.

Increased risk observed among patients aged 65 years or older.

“We suggest that providers caring for patients with CKD should anticipate a high likelihood that their patients may develop pruritus and, thus, incorporate frequent screening for pruritus and associated risk factors into routine clinical care,” Dr Wulczyn and colleagues concluded.

Depressive symptoms and weight, they wrote, “warrant further investigation as potentially modifiable risk factors that could be targets for a multifaceted approach to the treatment of pruritus in CKD.” ■