Prognostic Significance of Chronic Kidney Disease-Associated Pruritus: A Systematic Review and Meta-analysis of Mortality, Hospitalization, and Dialysis-Related Outcomes

Ujala Rani; Sooraj Raja

doi:10.53778/pjkd103371

المؤلفون

Ujala Rani Jinnah Postgraduate Medical Center
Sooraj Raja Jinnah Sindh Medical University

DOI:

https://doi.org/10.53778/pjkd103371

الكلمات المفتاحية:

Pruritus، Renal Insufficiency، Chronic; Renal Dialysis، Mortality، Hospitalization

الملخص

Chronic kidney disease-associated pruritus (CKD-aP), historically termed uremic pruritus, is a common and burdensome symptom in patients with advanced chronic kidney disease, hemodialysis, and peritoneal dialysis. Although previous reviews have emphasized prevalence, sleep disturbance, psychological burden, treatment response, and health-related quality of life, the prognostic significance of CKD-aP for hard clinical outcomes remains uncertain. We systematically reviewed studies published from January 1, 2000 to May 31, 2026 that evaluated CKD-aP or itch as a prognostic exposure in adults with chronic kidney disease or kidney failure. Outcomes included all-cause mortality, hospitalization, cardiovascular outcomes, infection-related outcomes, peritoneal dialysis outcomes, dialysis-related outcomes, and healthcare utilization. Risk of bias was assessed using QUIPS, and comparable adjusted hazard ratios for all-cause mortality in hemodialysis cohorts were pooled using DerSimonian-Laird random-effects models, with REML Hartung-Knapp analyses used for robustness. Proxy exposure studies, composite endpoints, and non-comparable effect measures were excluded from the primary quantitative model. Twenty-two reports were retained. In the primary model, severe or extreme CKD-aP was associated with higher all-cause mortality among hemodialysis patients (2 studies; pooled HR 1.33, 95% CI 1.07-1.65; I2 = 39.6%). A sensitivity model including one additional cohort showed a similar association (HR 1.42, 95% CI 1.12-1.80; I2 = 44.7%), although Hartung-Knapp intervals were imprecise and crossed the null. Secondary clinical outcomes were relevant but heterogeneous and were synthesized narratively. Severe CKD-aP may identify higher-risk hemodialysis patients, but certainty of evidence remains low. These findings should be interpreted cautiously in clinical practice and research.

السيرة الشخصية للمؤلف

Sooraj Raja، Jinnah Sindh Medical University

Medicine, Resident

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