Burden of pruritus in older non-dialysis CKD stage 4-5 patients: 7-year follow-up of the EQUAL study

Background and hypothesis. Chronic Kidney Disease-associated Pruritus (CKD-aP) is among the top 10 most prevalent and burdensome symptoms in kidney failure, but little is known in CKD stage 4-5 patients. Therefore, the aim of this study is to investigate the prevalence, incidence, and burden of pruritus in older non-dialysis (ND) CKD stage 4-5 patients. Methods. The European Quality (EQUAL) study is a prospective, multicenter study involving patients aged ≥65 years with an incident drop in eGFR to ≤20 ml/min/1.73m2. Pruritus presence and burden were assessed every 3-6 months between March 2012 and May 2022, using the Dialysis Symptom Index with a five-point Likert scale. High burden was defined as a score 4-5. Cumulative incidence of pruritus was estimated with the cumulative incidence function. Results. We included 1,380 patients who completed at baseline the pruritus question (yes/no). Patients were observed for a maximum of 7 years. At baseline, 66% were men, mean(SD) for age was 76(7) years, for eGFR 17(5) ml/min/1.73m2, for serum phosphate 1.3(0.3) mmol/L, 41% had diabetes, and 47% had cardiovascular disease. At baseline, 53% reported having pruritus, and 26% experienced a high burden. During 7-years of follow-up, the average proportion of patients with pruritus was 55%, with a mean burden score of 2.8 (95%CI: 2.8 to 2.9). Pruritus status was dynamic, with >10% of patients alternating between presence and absence every six months. Among those initially without pruritus, the 7-year cumulative incidence was 43% (95%CI: 39 to 47%). Conclusions. Pruritus affected approximately 55% of older patients with ND-CKD stage 4–5, with one in four reporting a high symptom burden. Pruritus status was dynamic over time. These findings highlight the need for greater awareness among healthcare professionals and underscore the importance of timely recognition and management of pruritus, with the potential to improve patients’ quality of life.