Association of pruritus with comorbidities and survival in chronic kidney disease: a narrative review of the pre-difelikefalin era literature.
Pruritus in chronic kidney disease is associated with increased mortality, cardiovascular events, and mental health issues, but the significance of these associations can vary based on confounding factors.
Where it sits
this study against the rest of the erythropoietin (epo) corpusSummary and findings
This narrative review evaluated the association between pruritus and comorbidities or survival in chronic kidney disease (CKD) prior to the approval of difelikefalin. The analysis included 37 studies, of which 18 identified a statistically significant association between CKD-associated pruritus (CKD-aP) and mortality. The review also noted significant links between CKD-aP and sleep disturbance, cardiovascular events, mental health issues, and increased healthcare costs.
Abstract
Pruritus is a frequent and distressing symptom in chronic kidney disease (CKD). This study aimed to evaluate the association between pruritus and comorbidities or survival in CKD before the approval of difelikefalin (DFK), a novel treatment for CKD-associated pruritus (CKD-aP). A systematic literature review was conducted using PubMed and Embase, including studies published between January 2000 and August 2022 that examined the link between CKD-aP and morbidity or survival in CKD. We analyzed 5,867 title/abstracts (3,541 from Pubmed, 2,313 from Embase, and nine additional articles) and excluded 5,721 references. Thirty-seven of the 146 articles that were eligible for full reading were included in the analysis. Thus, 18 identified a statistically significant association between CKD-aP and mortality. However, this association lost significance in 3 studies after adjusting for sleep. Two additional studies found no association between CKD-aP and mortality. In terms of sleep disturbance, 14 out of 15 studies reported a significant link with CKD-aP. Moreover, six studies demonstrated relationship between CKD-aP and cardiovascular events, which remained robust even after adjusting for diabetes. The connection between CKD-aP and mental health and depressive symptoms was investigated in 20 studies, with 18 confirming a significant association between the outcomes. Finally, six studies indicated that healthcare costs were higher in CKD-aP compared to those without. Pruritus appears to be associated with increased mortality, cardiovascular events, depressive symptoms, and healthcare costs in CKD patients. Early detection and treatment, particularly with new drugs like DFK, may improve patients' quality of life and reduce CKD-aP related.
Background
The paper addresses the prevalence and implications of pruritus in patients with chronic kidney disease (CKD), a condition known to significantly affect quality of life. Prior studies have suggested a potential link between pruritus and various comorbidities in CKD, but comprehensive insights into these associations have been limited. Understanding these relationships is crucial for improving patient management and outcomes in CKD.
Methods
This is a narrative review of literature published before the introduction of difelikefalin, focusing on studies that explore the relationship between pruritus and comorbidities in CKD. The review synthesizes findings from multiple studies without a specific population or sample size mentioned. No specific doses, durations, or outcome measures are reported.
Results
Not reported in abstract.
Interpretation
The review highlights the need for further research into the impact of pruritus on CKD patients, especially regarding its association with comorbidities and survival. However, without concrete data or specific findings, it is difficult to assess the clinical significance of the associations discussed. The lack of quantitative results limits the ability to compare these findings against existing literature or to draw definitive conclusions.
Key findings
- Not reported in abstract.
Limitations
- Not reported in abstract.
- No specific numeric findings provided.
- Narrative review without original data.
- Limited insights into clinical significance.