{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:24:24Z","timestamp":1791944664866,"version":"4.3.4"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pruritus is a common symptom experienced by patients with nondialysis CKD, but risk factors for incident pruritus in this patient population have not been evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified 1951 participants with CKD in the Chronic Renal Insufficiency Cohort Study without pruritus at the baseline assessment. Pruritus was assessed by the Kidney Disease Quality of Life-36 (KDQOL-36) instrument, and moderate-to-severe pruritus was defined as a response of 3 or higher on a Likert scale of 1\u20135. We used time-updated multivariable joint models to evaluate the association of patient clinical characteristics, eGFR, and laboratory parameters with incident pruritus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over a median follow-up of 6 years, 660 (34%) participants developed incident moderate-to-severe pruritus, with a higher incidence rate observed among participants with more advanced CKD. In multivariable models, the hazard ratio (95% confidence interval [CI]) for pruritus associated with a 10 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      lower eGFR was 1.16 (95% CI, 1.10 to 1.23). Older age (\u226565 years), higher body mass index, diabetes, current smoking, opioid use, depressive symptoms, and serum parathyroid hormone were also associated with a higher risk of incident pruritus, whereas low serum calcium (&lt;9 mg\/dl) was associated with a lower risk (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.05). Serum phosphate was not associated with incident pruritus in the primary analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A substantial proportion of patients with nondialysis CKD develop moderate-to-severe pruritus. Although lower eGFR is associated with the risk of pruritus, other comorbidities, particularly depressive symptoms, were potential risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Podcast<\/jats:title>\n                    <jats:p>This article contains a podcast at https:\/\/dts.podtrac.com\/redirect.mp3\/www.asn-online.org\/media\/podcast\/CJASN\/2023_02_08_CJN09480822.mp3<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.09480822","type":"journal-article","created":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T13:45:15Z","timestamp":1671025515000},"page":"193-203","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":21,"title":["Incidence and Risk Factors for Pruritus in Patients with Nondialysis CKD"],"prefix":"10.2215","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4832-0209","authenticated-orcid":false,"given":"Kendra E.","family":"Wulczyn","sequence":"first","affiliation":[{"name":"Nephrology Division, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene P.","family":"Rhee","sequence":"additional","affiliation":[{"name":"Nephrology Division, Massachusetts General Hospital, Boston, Massachusetts"},{"name":"Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2478-0331","authenticated-orcid":false,"given":"Leslie","family":"Myint","sequence":"additional","affiliation":[{"name":"Macalester College, St. Paul, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1746-5790","authenticated-orcid":false,"given":"Sahir","family":"Kalim","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7222-4666","authenticated-orcid":false,"given":"Tariq","family":"Shafi","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Houston Methodist Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,1,2]]},"reference":[{"issue":"5","key":"B1-20241015","doi-asserted-by":"crossref","first-page":"673","DOI":"10.2215\/CJN.09600818","article-title":"Pruritus and patient reported outcomes in non-dialysis CKD","volume":"14","author":"Sukul","year":"2019","journal-title":"Clin J Am Soc Nephrol."},{"issue":"4","key":"B2-20241015","doi-asserted-by":"crossref","first-page":"496","DOI":"10.2215\/CJN.13010921","article-title":"Trajectories of uremic symptom severity and kidney function in patients with chronic kidney disease","volume":"17","author":"Wulczyn","year":"2022","journal-title":"Clin J Am Soc Nephrol."},{"issue":"4","key":"B3-20241015","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1007\/s11255-015-1208-5","article-title":"Epidemiology and determinants of pruritus in pre-dialysis chronic kidney disease patients","volume":"48","author":"Solak","year":"2016","journal-title":"Int Urol Nephrol."},{"issue":"6","key":"B4-20241015","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1159\/000518391","article-title":"Chronic kidney disease-associated pruritus: a review","volume":"46","author":"Makar","year":"2021","journal-title":"Kidney Blood Press Res."},{"issue":"10","key":"B5-20241015","doi-asserted-by":"crossref","first-page":"3338","DOI":"10.1093\/ndt\/gfr053","article-title":"Interleukin-2 serum levels are elevated in patients with uremic pruritus: a novel finding with practical implications","volume":"26","author":"Fallahzadeh","year":"2011","journal-title":"Nephrol Dial Transplant."},{"issue":"3","key":"B6-20241015","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1093\/ndt\/gfi204","article-title":"The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients","volume":"21","author":"Kimmel","year":"2006","journal-title":"Nephrol Dial Transplant."},{"issue":"1021","key":"B7-20241015","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1136\/pgmj.2009.095745","article-title":"Comparison of cutaneous manifestations in chronic kidney disease with or without dialysis","volume":"86","author":"Khanna","year":"2010","journal-title":"Postgrad Med J."},{"issue":"2","key":"B8-20241015","first-page":"964","article-title":"Clinical features and risk factors of pruritus in patients with chronic renal failure","volume":"18","author":"Hu","year":"2019","journal-title":"Exp Ther Med."},{"issue":"12","key":"B9-20241015","doi-asserted-by":"crossref","first-page":"3495","DOI":"10.1093\/ndt\/gfl461","article-title":"Pruritus in haemodialysis patients: international results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"21","author":"Pisoni","year":"2006","journal-title":"Nephrol Dial Transplant."},{"issue":"1","key":"B10-20241015","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1590\/S0365-05962011000100003","article-title":"Avalia\u00e7\u00e3o da associa\u00e7\u00e3o entre as altera\u00e7\u00f5es no metabolismo mineral e o prurido nos pacientes em hemodi\u00e1lise","volume":"86","author":"Welter","year":"2011","journal-title":"Bras Dermatol."},{"issue":"09","key":"B11-20241015","doi-asserted-by":"crossref","first-page":"184","DOI":"10.5414\/CNP66184","article-title":"Uremic pruritus is associated with higher kt\/V and serum calcium concentration","volume":"66","author":"Duque","year":"2006","journal-title":"Clin Nephrol."},{"issue":"1","key":"B12-20241015","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1093\/ndt\/gfn449","article-title":"Symptom clusters in incident dialysis patients: Associations with clinical variables and quality of life","volume":"24","author":"Thong","year":"2008","journal-title":"Nephrol Dial Transplant."},{"issue":"1","key":"B13-20241015","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1053\/j.ajkd.2011.12.033","article-title":"Factors associated with depressive symptoms and use of antidepressant medications among participants in the Chronic Renal Insufficiency Cohort (CRIC) and Hispanic-CRIC Studies","volume":"60","author":"Fischer","year":"2012","journal-title":"Am J Kidney Dis."},{"issue":"8","key":"B14-20241015","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.2215\/CJN.01210122","article-title":"Anxiety, comorbid depression, and dialysis symptom burden","volume":"17","author":"Cukor","year":"2022","journal-title":"Clin J Am Soc Nephrol."},{"issue":"suppl 2","key":"B15-20241015","doi-asserted-by":"crossref","first-page":"S148","DOI":"10.1097\/01.ASN.0000070149.78399.CE","article-title":"The Chronic Renal Insufficiency Cohort (CRIC) study: design and methods","volume":"14","author":"Feldman","year":"2003","journal-title":"J Am Soc Nephrol."},{"issue":"2","key":"B16-20241015","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1053\/j.ajkd.2012.04.012","article-title":"Estimating GFR among participants in the Chronic Renal Insufficiency cohort (CRIC) study","volume":"60","author":"Anderson","year":"2012","journal-title":"Am J Kidney Dis."},{"key":"B17-20241015","first-page":"1","article-title":"Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms","volume":"7","author":"Sood","year":"2013","journal-title":"Int J Nephrol Renovascular Dis."},{"issue":"3","key":"B18-20241015","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/hdi.12158","article-title":"Pruritus in hemodialysis patients: results from the Japanese Dialysis Outcomes and Practice Patterns Study (JDOPPS)","volume":"18","author":"Kimata","year":"2014","journal-title":"Hemodial Int."},{"key":"B19-20241015","first-page":"CD012509","article-title":"Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: An overview of cochrane reviews","volume":"10","author":"Els","year":"2017","journal-title":"Cochrane Database Syst Rev."},{"issue":"2","key":"B20-20241015","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.ekir.2018.10.001","article-title":"Depressive symptoms associate with race and all-cause mortality in patients with CKD","volume":"4","author":"Tuot","year":"2019","journal-title":"Kidney Int Rep."},{"issue":"3","key":"B21-20241015","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1053\/j.ajkd.2009.03.016","article-title":"Validation of depression screening scales in patients with CKD","volume":"54","author":"Hedayati","year":"2009","journal-title":"Am J Kidney Dis."},{"issue":"5","key":"B22-20241015","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/BF00451725","article-title":"Development of the kidney disease quality of life (KDQOLTM) instrument","volume":"3","author":"Hays","year":"1994","journal-title":"Qual Life Res."},{"issue":"7","key":"B23-20241015","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.2215\/CJN.19031220","article-title":"Kidney disease symptoms before and after kidney transplantation","volume":"16","author":"Taylor","year":"2021","journal-title":"Clin J Am Soc Nephrol."},{"issue":"1","key":"B24-20241015","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1177\/1536867X1301300112","article-title":"Joint modeling of longitudinal and survival data","volume":"13","author":"Crowther","year":"2013","journal-title":"Stata J Promoting Commun Stat Stata."},{"issue":"2","key":"B25-20241015","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1093\/ckj\/sfaa024","article-title":"An introduction to joint models\u2014applications in nephrology","volume":"13","author":"Chesnaye","year":"2020","journal-title":"Clin Kidney J."},{"issue":"4","key":"B26-20241015","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1038\/sj.bjc.6601120","article-title":"Survival Analysis Part III: multivariate data analysis\u2014choosing a model and assessing its adequacy and fit","volume":"89","author":"Bradburn","year":"2003","journal-title":"Br J Cancer."},{"key":"B27-20241015","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/S0272-6386(96)90039-6","article-title":"Logical and statistical fallacies in the use of Cox regression models","volume":"27","author":"Wolfe","year":"1996","journal-title":"Am J Kidney Dis."},{"issue":"19","key":"B28-20241015","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C\u2013based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med."},{"issue":"1","key":"B29-20241015","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/EDE.0b013e3181c1ea43","article-title":"The hazards of hazard ratios","volume":"21","author":"Hern\u00e1n","year":"2010","journal-title":"Epidemiology."},{"issue":"21","key":"B30-20241015","doi-asserted-by":"crossref","first-page":"e10633","DOI":"10.1097\/MD.0000000000010633","article-title":"Prevalence of chronic kidney disease-associated pruritus among adult dialysis patients: a meta-analysis of cross-sectional studies","volume":"97","author":"Hu","year":"2018","journal-title":"Medicine (Baltimore)."},{"issue":"8","key":"B31-20241015","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.2215\/CJN.00100110","article-title":"A longitudinal study of uremic pruritus in hemodialysis patients","volume":"5","author":"Mathur","year":"2010","journal-title":"Clin J Am Soc Nephrol."},{"issue":"9","key":"B32-20241015","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1038\/sj.ki.5000251","article-title":"Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients","volume":"69","author":"Narita","year":"2006","journal-title":"Kidney Int."},{"issue":"2","key":"B33-20241015","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.jpainsymman.2011.08.005","article-title":"Symptom burden and associated factors in renal transplant patients in the U.K","volume":"44","author":"Afshar","year":"2012","journal-title":"J Pain Symptom Manage."},{"issue":"2","key":"B34-20241015","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1111\/j.1365-2133.2009.09088.x","article-title":"Depressive symptoms predict the future risk of severe pruritus in haemodialysis patients: Japan Dialysis Outcomes and Practice Patterns Study","volume":"161","author":"Yamamoto","year":"2009","journal-title":"Br J Dermatol."},{"issue":"3","key":"B35-20241015","doi-asserted-by":"crossref","first-page":"425","DOI":"10.3390\/ijms17030425","article-title":"Nocturnal pruritus: the battle for a peaceful night\u2019s sleep","volume":"17","author":"Lavery","year":"2016","journal-title":"Int J Mol Sci."},{"issue":"4","key":"B36-20241015","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1590\/abd1806-4841.20175402","article-title":"The relationship between pruritus and clinical variables in patients with psoriasis","volume":"92","author":"Bahali","year":"2017","journal-title":"Bras Dermatol."},{"issue":"1","key":"B37-20241015","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1038\/jid.1952.62","article-title":"Experimental histamine Pruritus1","volume":"19","author":"Cormia","year":"1952","journal-title":"J Invest Dermatol."},{"issue":"2","key":"B38-20241015","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/jorc.12152","article-title":"Which patients with chronic kidney disease have the greatest symptom burden? A comparative study of advanced CKD stage and dialysis modality","volume":"42","author":"Almutary","year":"2016","journal-title":"J Ren Care."},{"key":"B39-20241015","doi-asserted-by":"crossref","first-page":"155369","DOI":"10.1016\/j.cyto.2020.155369","article-title":"Elevated interleukin 31 serum levels in hemodialysis patients are associated with uremic pruritus","volume":"138","author":"Oweis","year":"2021","journal-title":"Cytokine."},{"issue":"2","key":"B40-20241015","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.jaci.2005.10.033","article-title":"IL-31: a new link between T cells and pruritus in atopic skin inflammation","volume":"117","author":"Sonkoly","year":"2006","journal-title":"J Allergy Clin Immunol."},{"issue":"2","key":"B41-20241015","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1093\/brain\/awaa430","article-title":"Central opioid receptors mediate morphine-induced itch and chronic itch via disinhibition","volume":"144","author":"Wang","year":"2021","journal-title":"Brain."},{"key":"B42-20241015","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.neuroscience.2013.07.035","article-title":"Neural processing of itch","volume":"250","author":"Akiyama","year":"2013","journal-title":"Neuroscience."},{"key":"B43-20241015","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1056\/NEJMoa1912770","article-title":"A phase 3 trial of difelikefalin in hemodialysis patients with pruritus","volume":"382","author":"Fishbane","year":"2020","journal-title":"N Engl J Med."},{"issue":"11","key":"B44-20241015","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1001\/jamadermatol.2021.3829","article-title":"Improvement of chronic kidney disease-associated pruritus after treatment with intravenous naloxone","volume":"157","author":"Pereira","year":"2021","journal-title":"JAMA Dermatol."},{"issue":"6","key":"B45-20241015","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1053\/j.jrn.2013.08.002","article-title":"Longitudinal predictors of uremic pruritus","volume":"23","author":"Shirazian","year":"2013","journal-title":"J Ren Nutr."},{"issue":"2","key":"B46-20241015","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1159\/000458417","article-title":"Total calcium and albumin are decreased in the deeper epidermis of patients with chronic kidney disease-associated pruritus","volume":"136","author":"Momose","year":"2017","journal-title":"Nephron."},{"issue":"13","key":"B47-20241015","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1056\/NEJM196809262791308","article-title":"Intractable pruritus as a manifestation of secondary hyperparathyroidism in uremia. Disappearance of itching after subtotal parathyroidectomy","volume":"279","author":"Massry","year":"1968","journal-title":"N Engl J Med."},{"issue":"2","key":"B48-20241015","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1111\/j.1492-7535.2005.01130.x","article-title":"Uremic pruritus: a review","volume":"9","author":"Lugon","year":"2005","journal-title":"Hemodialysis Int."}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.09480822","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:44:56Z","timestamp":1786369496000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.09480822"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,2]]},"references-count":48,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.09480822","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,2]]},"assertion":[{"value":"2022-08-12","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-14","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}