Pruritus and insomnia in hemodialysis patients; Association with SF36 quality of life and clinical outcomes

Abstract

Introduction: Pruritus involves many hemodialysis (HD) patients and has a close association with sleep quality and health-related quality of life. Objectives: The aim of this study was to determine predictors of pruritus and insomnia, the effect of pruritus on the severity of sleeping difficulties, and also their impacts on the health quality, hospitalization and mortality in a multicenter cohort of HD patients. Patients and Methods: Pruritus and sleep problems data were obtained in 416 HD patients from nine dialysis facilities in September 2012. SF36 quality of life and a comprehensive questionnaire was provided for the patients. Patients were followed for a median of 28 months. Unadjusted and adjusted odds ratio (AOR) of having pruritus/sleep disturbances for different variables and relative risk of death was calculated. Results. Moderate to extreme pruritus and insomnia were respectively identified in 38% and 49% of HD patients. Independent predictors of having severe to extreme pruritus were hyperphosphatemia (mg/dL) (AOR: 1.34; 95% CI: 1.06-1.70), anemia (g/dL) (AOR: 1.27; 95% CI: 1.04-1.56), and older age (year) (AOR: 1.02; 95% CI: 1.00-1.04). These predictors for severe to extreme insomnia were dialysis vintage (year) (AOR: 1.14; 95% CI: 1.04-1.26), worse bodily pain (AOR: 1.01; 95% CI: 1.00-1.03), poor mental health (AOR: 1.02; 95% CI: 1.01-1.04), and severe to extreme pruritus (AOR: 8.80; 95% CI: 3.24-23.91). SF36 quality of life was becoming significantly lower with increasing the degree of pruritus/insomnia. Likewise, hospitalization was more common in these patients. During the follow up 123 (29.6%) patients passed away. The full-adjusted relative risk of death for extreme insomnia was 1.72 (95% CI: 1.00-3.03; P = 0.05). Conclusion: Moderate to extreme pruritus/insomnia are quite common in HD patients and significantly affect quality of life. Pruritus is a great predictor of insomnia. Extreme insomnia is an independent predictor of death.