{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:47:48Z","timestamp":1790650068807,"version":"4.1.0"},"reference-count":49,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Kidney Health Dis"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Chronic kidney disease-associated pruritus (CKD-aP) is a distressing symptom associated with dialysis that negatively affects quality of life. Chronic kidney disease-associated pruritus is under-recognized due to a lack of clinical attention and symptom screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Assess the prevalence and severity of CKD-aP in a regional hemodialysis program.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and Patients:<\/jats:title>\n                    <jats:p>All outpatients receiving in-center hemodialysis at the Kingston Health Sciences Centre.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>Patients were asked to complete the Worst Itching Intensity Numerical Scale (WI-NRS), with moderate-to-severe pruritus classified as a score greater than 4, and the Self-Assessed Disease Severity (SADS) scale. Demographic, laboratory, and prescription data were extracted from patient medical records and patients were asked to self-report over-the-counter pruritus medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Comparative differences in demographics and laboratory values at the time of determining the WI-NRS and SADS were analyzed using a Fisher\u2019s exact test with Bonferroni correction for categorical variables and the Mann-Whitney\n                      <jats:italic>U<\/jats:italic>\n                      test for continuous variables. Correlations between select variables and the WI-NRS score were assessed using linear regression analyses. Adjusted associations with moderate-to-severe CKD-aP were examined using odds ratios with corresponding 95% confidence intervals.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 307 patients completed the WI-NRS and 302 completed the SADS. Fifty-seven percent of patients reported some degree of CKD-aP, 31% of patients had moderate-to-severe CKD-aP, and 9% reported interference with quality of life (patients in SADS group C). Patients with moderate-to-severe CKD-aP and those significantly affected by CKD-aP (patients in SADS group C) were more likely to use over-the-counter treatments than patients with mild or no CKD-aP (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .0001) and patients in SADS group A (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .0001), respectively. Of patients with moderate-to-severe CKD-aP and whose CKD-aP significantly affected their quality of life (patients in SADS group C), 42% and 11.11%, respectively, did not use any form of treatments. Patients with moderate-to-severe CKD-aP had significantly higher parathyroid hormone (PTH; 0.02) and phosphate (\n                      <jats:italic>P<\/jats:italic>\n                      = .01). A higher body mass index (BMI) was associated with a greater WI-NRS score (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0.030,\n                      <jats:italic>P<\/jats:italic>\n                      = .003). Of patients with moderate-to-severe CKD-aP, 24% reported significant debilitation (patients in SADS group C). Finally, adjusted associations were found between moderate-to-severe CKD-aP and the following variables: BMI (OR = 1.05, 95% CI = 1.01-1.09,\n                      <jats:italic>P<\/jats:italic>\n                      = .02); serum phosphate (OR = 2.12, 95% CI = 1.15-4.00,\n                      <jats:italic>P<\/jats:italic>\n                      = .02); being a current smoker (OR = 0.46, 95% CI = 0.20-0.95,\n                      <jats:italic>P<\/jats:italic>\n                      = .04); and a serum phosphate greater than or equal to 1.8 mmol\/L (OR = 2.33, 95% CI = 1.29-4.26,\n                      <jats:italic>P<\/jats:italic>\n                      = .01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations:<\/jats:title>\n                    <jats:p>There were some missing data points in patient records and patients\u2019 reports of over-the-counter medications. We could not assess whether patients actually had CKD-aP, or pruritus due to other causes. Treatment adherence could not be measured as well as whether treatments were specifically prescribed for CKD-aP. Moreover, our electronic medical record system could not capture prescribed topicals or pruritus-related medical conditions. Finally, this study did not assess physician\u2019s awareness of CKD-aP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A substantial proportion of patients with moderate-to-severe CKD-aP reported a significant impact on quality of life. Elevated PTH, phosphate, and BMI were associated with CKD-aP. In addition, almost half of patients with moderate-to-severe CKD-aP did not use any treatments. There exist gaps and opportunities for care for patients with CKD-aP. Increased clinical attention to CKD-aP could identify those who may benefit from care interventions that improve quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20543581251380541","type":"journal-article","created":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T14:07:29Z","timestamp":1759068449000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Prevalence and Severity of Pruritus in Patients on Hemodialysis: A Cross-Sectional Study"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6505-6978","authenticated-orcid":false,"given":"Hannah G.","family":"McMaster","sequence":"first","affiliation":[{"name":"Department of Medicine, Queen\u2019s University, Kingston, ON, Canada"},{"name":"Department of Nephrology, Kingston Health Sciences Centre, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6431-3127","authenticated-orcid":false,"given":"Rachel M.","family":"Holden","sequence":"additional","affiliation":[{"name":"Department of Medicine, Queen\u2019s University, Kingston, ON, Canada"},{"name":"Department of Nephrology, Kingston Health Sciences Centre, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kingston Health Sciences Centre, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Iliescu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Queen\u2019s University, Kingston, ON, Canada"},{"name":"Department of Nephrology, Kingston Health Sciences Centre, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,28]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2020.08.011"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.09600818"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-015-1208-5"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.03280317"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfl461"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00100110"},{"key":"e_1_3_2_8_2","first-page":"1","article-title":"Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms","volume":"7","author":"Ramakrishnan K","year":"2013","unstructured":"Ramakrishnan K, Bond TC, Claxton A, et al. 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