Pruritus In Patients On Maintenance Haemodialysis At Kenyatta National Hospital: Quality Of Life And Associated Factors

Abstract

Dialysis associated pruritus causes impairment in quality of life and increases mortality. Even then, it is not well characterized and hence lacks effective treatment. Objectives: To estimate the extent and disability impact of haemodialysis associated itch, and their relationship with clinical and laboratory characteristics among patients on maintenance haemodialysis at a tertiary health facility. Study design: A cross sectional survey was conducted among patients on maintenance haemodialysis at Kenyatta National Hospital renal unit. Sample size and sampling technique: One hundred and nine participants were enrolled, determined using Daniel’s formula for finite populations. Total population purposive sampling technique was adopted. Methodology: Researcher-administered questionnaire, aimed at collecting relevant patients’ biodata, haemodialysis vintage, average number of dialysis hours per week and co-morbid conditions, was used. Pruritus was diagnosed by a score of ˃ 5 on a 5D itch scale that was administered to those who reported to experience itching. Chart review was carried out to collect the following laboratory information; haemoglobin, mean corpuscular volume, calcium, phosphorus, creatinine, urea and albumin. Prevalence of pruritus, and pruritus disability scores were ascertained. Analysis was done to interrogate the relationship between pruritus and highlighted variables. The same was done for pruritus disability score categories. Results: One hundred and nine participants were enrolled, 51.4% being male. The mean age was 46.6(SD: 15.9) years. The commonest cause of ESRD was chronic glomerulonephritis (35.8%), followed by diabetes mellitus (24.8%), then hypertension (21.1%). Thirty-seven (33.9%) participants had pruritus. Among those with pruritus,18.9 % had pruritus disability scores > 3. Xerosis was significantly associated with pruritus (75.7% vs 29.2%, P<0. 001). There was no association between laboratory characteristics and pruritus. Urine output < 200mLs in 24 hours was associated with higher pruritus disability scores (52.1% vs 6.7%, p=0.001). Likewise, absence of anaemia correlated positively with higher pruritus disability scores, (14.3% vs 0.0%, p = 0.046). Conclusions: The prevalence of pruritus among patients on maintenance haemodialysis at Kenyatta National Hospital is 33.9%. Xerosis predicted the occurrence of pruritus. Urine output < 200mLs in 24 hours and absence of anaemia predicted higher pruritus disability scores, reflecting significant impairment in quality of life.