ORLANDO – Itchy dialysis patients are less likely to keep their appointments, researchers reported here.
In a review of data from a large dialysis provider, patients with the most severe self-reported levels of itchiness or dryness missed, on average, 2.6 more dialysis sessions per year compared with those who had neither symptom, Scott Sibbel, PhD, of DaVita, and colleagues reported at the National Kidney Foundation meeting.
Mahesh Krishnan, MD, vice president of clinical research at DaVita, who was not involved in this poster but spoke on behalf of the researchers, said that if clinicians "can improve quality of life, it can be beneficial in preventing patients from not getting the full treatment of dialysis," which could ultimately help reduce common comorbidities associated with missed visits.
Dialysis organizations have ramped up interest in quality of life (QOL) over the last 2 to 3 years, since it has been included in the conditions for coverage for Medicare reimbursement.
"We're moving beyond looking at the biochemical things we've been obsessed with, like body mass index or anemia, and moving into thinking about QOL," he told MedPage Today.
One of those QOL issues is pruritus, a problem that has long plagued dialysis patients, but had taken a back seat to more serious complications, he said.
It is generally treated with skin creams or antihistamines, but there's little evidence to support these therapies. The one therapy that has been well studied is UVB phototherapy, but it is not widely used.
Some pharmaceutical companies have become interested in developing drugs for pruritus in dialysis patients, and one such product is a highly selective kappa-opioid receptor agonist made by Tokyo-based Mitsubishi Pharmaceuticals, which funded the current observational study.
To see whether itchy or dry skin had any relationship with missed dialysis sessions, the researchers looked at data from their large registry on 38,315 patients treated between Dec. 2008 and June 2012.
All had taken the self-reported Kidney Disease Quality of Life (KDQOL) survey, which looks at health-related quality of life for those with end-stage renal disease (ESRD) on dialysis. Patients were included if they had a KDQOL assessment more than 3 months after starting dialysis and had Medicare as their primary payer.
Overall, 20% of patients were either "very" or "extremely" bothered by skin itchiness or dryness, and 32% said they were "moderately" bothered.
The researchers found that missed dialysis sessions were associated with increasing levels of itchiness or dryness severity.
For instance, patients who were "extremely" bothered by their itchiness missed 4.9 dialysis sessions in the 6 months following the KDQOL survey, compared with 3.6 missed sessions for those who were not bothered at all by itching.
There was a similar pattern for dryness scores, with 4.8 missed sessions for those who were "extremely" bothered compared with 3.5 sessions for those who weren't bothered at all.
The authors concluded that itchiness is a significant, independent predictor of compliance and should be addressed.
"Given that long intra-dialytic intervals have been associated with increased all-cause, cardiac-related and infection-related mortality, the relationship between intra-dialytic intervals, missed visits, and skin itchiness/dryness warrants further investigation," they wrote.
Andrew Cohen, MD, chief of nephrology at the VA Medical Center in Providence, R.I., who was not involved in the study, agreed that pruritus is something that should be taken seriously.
"Unfortunately, despite 50 years of dialysis experience, we still don't know what causes itchiness," he told MedPage Today, noting that several hypotheses, such as elevated phosphorus or parathyroid hormone, have been eliminated.
"Because it doesn't manifest itself as an issue that leads to mortality, it hasn't been given the same kind of weight as other symptoms or problems in patients with dialysis, but it's a serious problem because it's so ubiquitous," he said.
However, given the observational nature of the study, Cohen said he's "not really convinced that it shows me that if I gave somebody a treatment to make them less itchy, that they would appear for more dialysis. There are a whole lot of other factors that would make them noncompliant."
The study was supported by Mitsubishi Tanabe Pharma Corporation.
The researchers reported no conflicts of interest.
Primary source: National Kidney Foundation
Source reference:
Graham C, et al "Missed dialysis sessions and impact of pruritus among Medicare patients receiving hemodialysis at a large dialysis organization" NKF 2013.
Source reference:
Graham C, et al "Missed dialysis sessions and impact of pruritus among Medicare patients receiving hemodialysis at a large dialysis organization" NKF 2013.
No comments:
Post a Comment