Association of pruritus with comorbidities and survival in chronic kidney disease: a narrative review of the pre-difelikefalin era literature.
Justine Saucereau, Emilie Brenaut, Anne-Sophie Ficheux et al.
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In 30 seconds
This systematic literature review examined associations between chronic kidney disease–associated pruritus (CKD-aP) and comorbidities or survival in studies published from January 2000 to August 2022, before difelikefalin approval. Of 37 included studies, 18 reported a statistically significant association between pruritus and mortality, although three lost significance after adjustment for sleep and two found no association. Links were also commonly reported with sleep disturbance and depressive symptoms, and several studies found associations with cardiovascular events and higher healthcare costs. Overall, the review describes a substantial burden associated with CKD-aP, while findings on mortality were not uniform.
Key findings
- Eighteen studies reported a statistically significant association between CKD-aP and mortality; three lost significance after adjustment for sleep, and two found no association.
- Fourteen of 15 studies reported a significant link between CKD-aP and sleep disturbance.
- Eighteen of 20 studies found a significant association between CKD-aP and mental health or depressive symptoms.
- Six studies linked CKD-aP with cardiovascular events, and six reported higher healthcare costs than in patients without CKD-aP.
Why it matters
The review brings together evidence that pruritus in CKD often accompanies sleep disturbance, depressive symptoms, cardiovascular events, and greater healthcare costs. These associations highlight that CKD-aP may reflect a broader burden than itching alone. The mortality findings are less consistent, including attenuation after adjustment for sleep, so the review supports attention to symptom burden without establishing that pruritus causes adverse outcomes.
What to keep in mind
The review synthesizes heterogeneous studies, and the reported associations do not establish causality. Mortality findings were inconsistent, including loss of significance after adjustment for sleep in some studies.