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PROMs were captured electronically at predefined phases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>During Adjustment phases, individualized symptom reports were reviewed by physicians, prompting initiation of difelikefalin for CKD-aP or referral to psychiatric care for depressive symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcomes and measures<\/jats:title>\n                    <jats:p>Changes in itch (Worst-Itch Numerical Rating Scale, WI-NRS) and depression (Patient Health Questionnaire-9, PHQ-9) and concordance between patients and nurses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At baseline, 32% of patients versus 9% of nurses reported pruritus (\u03ba\u2009=\u20090.18) and 27% versus 6% reported depression (\u03ba\u2009=\u20090.19). Following PROM-guided interventions, 16 patients initiated difelikefalin (median WI-NRS reduction of 3 points,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and five were referred for psychiatric care (median PHQ-9 reduction of 4.5 points,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015). Patient\u2013nurse agreement improved to \u03ba\u2009=\u20090.66 for pruritus and \u03ba\u2009=\u20090.65 for depression at study end. Ratings of assessment adequacy rose from 38% to 67% among patients and from 55% to 75% among nurses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and relevance<\/jats:title>\n                    <jats:p>Routine, repeated PROMs markedly improved recognition of CKD-aP and depression, enabled targeted therapy with meaningful relief, and strengthened patient-staff alignment. This PDAS-based strategy supports KDIGO guidance and merits broader adoption to advance patient-centered dialysis care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s41687-026-01003-6","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:33:58Z","timestamp":1769002438000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Reduction of pruritus and depression using longitudinal patient-reported outcome measures in hemodialysis: a quality improvement project"],"prefix":"10.1186","volume":"10","author":[{"given":"Luis","family":"Naar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Mussnig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janosch","family":"Niknam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Brosch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Krenn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher C.","family":"Mayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Beige","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfred","family":"Hecking","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"1003_CR1","unstructured":"Mehrotra R, Davison SN, Farrington K, Flythe JE, Foo M, Madero M et al (2023 Sept) Managing the symptom burden associated with maintenance dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. 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