Response of patients with hemodialysis-associated pruritus to new treatment algorithm with nalfurafine hydrochloride: A retrospective survey-based study

Abstract

Background: Pruritus in hemodialysis patients is a serious complication that lowers quality of life and adversely affects survival. Hemodialysis-associated pruritus has multiple causes and treatments; however, no effective treatment has been established and many cases are treatment-resistant. Nalfurafine hydrochloride, introduced in 2009 as a treatment for hemodialysis-associated pruritus, has been shown to alleviate itching in hemodialysis patients with existing therapy-resistant pruritus. Based on those reports, we reviewed our strategy for pruritus management in hemodialysis patients in June 2009 and established a new treatment algorithm, which included nalfurafine hydrochloride, modified drug therapy, and patient guidance on skin care and daily life. Methods: To evaluate the effectiveness of the new treatment algorithm, we conducted pre- A nd post-implementation surveys of 215 patients receiving maintenance hemodialysis. The first survey was performed in May 2009, before introduction of the algorithm, and the second in April 2013, 4 years after algorithm introduction. In both surveys, patients provided information about the presence of pruritus, its intensity, and their satisfaction with treatment. Results: The percentage of patients with pruritus decreased significantly from 83.3 to 69.8 % following algorithm introduction, accompanied by a significant reduction in the percentage of patients reporting severe itching (from 13.0 to 2.8 %). Furthermore, the percentage of patients with pruritus-related insomnia decreased from 12.6 to 4.7 %. Patient satisfaction with treatment improved significantly from 49.1 to 70.6 %. When analysis was confined to patients receiving nalfurafine hydrochloride as a component of pruritus management, the percentage of patients complaining of severe itching decreased from 46.7 to 0 % after the start of treatment. Conclusions: Our findings suggest that pruritus in hemodialysis patients can be improved with the introduction of a team-based treatment algorithm, consisting of drug therapy (including nalfurafine treatment), skin care, and daily-life guidance.