14 4 Academia Journal of Medicine ¦ Volume 2 ¦ Issue 2 ¦ July-December 2019 144 Section: Nephrology Abstract Prevalence of Uremic Pruritus, Its Risk Factors and Impact on Health- Related Quality-Of-Life in Patients on Maintenance Hemodialysis Simran Kaur 1 , Deepak Sharma 2 , Suman Sethi 1 , Preet Mohinder Singh Sohal 1 , Harmandeep Singh Chahal 3 , Vikas Makkar 4 1 Assistant Professor Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India, 2 Consultant Nephrologist, Sri Mata Vaishno Devi Narayana Superspeciality Hospital, Katra, Jammu and Kashmir, India, 3 Associate Professor Urology and Renal Transplant, Dayanand Medical College and Hospital, Ludhiana, Punjab, India, 4 Professor and Head Nephrology,Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Background: Renal pruritus is one of the most debilitating symptom of chronic kidney disease especially affecting patients on maintenance hemodialysis. Subjects and Methods: It was a cross-sectional questionnaire based study. Demographic, dialysis related and biochemical parameters of maintenance hemodialysis patients were recorded, and a pre-defined questionnaire was put to them. Severity was calculated with 12 point pruritus severity scale (PSS), health-related quality of life with SKINDEX-10, and sleep survey with ITCH-MOS. Results: The total of 164 patients (mean age 52 ± 17years, males-57.9%, females-42.1%) completing questionnaire and laboratory analysis were included in the study. Prevalence of pruritus was 53.7% (mild in 31.8%, moderate-45.5%, severe-22.7%). Prevalence was higher in diabetic CKD (p=0.0001), and irregularly dialyzed patients (p=0001). The severity of pruritus correlated with older age (p=0.004), shorter dialysis vintage (p=0.000), irregular dialysis (0.000), higher serum phosphorus (0.003), and parathyroid hormone level (0.000) and higher calcium-phosphorus product (0.001). SKINDEX-10 showed worsening symptoms, emotional and functional quality of life (p=0.000), and poorer sleep quality and quantity as per ITCH-MOS (0.000), with increasing severity of itching. Conclusion: Renal itch is highly prevalent in maintenance hemodialysis patients, most severely affecting diabetics, elderly, irregularly dialyzed patients, with poorly controlled mineral bone parameters. The severity correlates with worsening sleep and overall quality-of-life. Keywords: Uremia, uremic/renal pruritus, maintenance hemodialysis, health-related quality of life, sleep. Corresponding Author: Dr. Deepak Sharma, Consultant Nephrologist, Sri Mata Vaishno Devi Narayana Superspeciality Hospital, Katra, Jammu and Kashmir, India. Received: December 2019 Accepted: December 2019 Introduction Pruritus is one of the most bothersome symptom for chronic kidney disease (CKD), with reported prevalence as high as 50–90%. [1] It affects patients in all stages of CKD, irrespective of underlying etiology, gender, age or co- morbidities, however certain factors are hypothesized to affect its incidence and severity. Uremic pruritus significantly impairs the quality of life in CKD. The gravity of this seemingly trivial complaint can be judged from the fact that uremic pruritus has been an independent predictor of increased mortality, probably because its impact on the patient’s quality of sleep. [2-4] Despite advances in the care of end-stage renal disease (ESRD) patients, the management of pruritus remains one of the most challenging clinical problems for the treating nephrologist. The present study intended to analyze the prevalence of uremic pruritus in maintenance hemodialysis patients, its relationship with demographic and metabolic parameters, and its impact on their health-related quality-of-life (HR-QOL) and sleep. Subjects and Methods This cross-sectional study was done in a large tertiary care centre in North India, in patients undergoing maintenance hemodialysis (with more than three months of dialysis vintage). The study was approved by the institutional ethical committee and a written informed consent was taken from each patient before inclusion in the study. The demographic details, etiology of CKD, hemodialysis vintage and frequency was recorded for all the patients. All the patients were being dialyzed on B-Braun-Dialog+ slow-flux hemodialysis machines, with formalin sterilized reused dialyzers. The laboratory parameters including hemoglobin, calcium, phosphorus, calcium-phosphorus product and parathyroid hormone levels were done in all the patients. The prevalence, intensity and diurnal variation of pruritus, its correlation with metabolic parameters, and its impact on the health related quality-of-life (HR-QOL) and sleep of the patients was analyzed on the basis of a pre-defined performa including 12 point pruritus severity scale (PSS) for severity, [5] SKINDEX-10 for assessment of HR-QOL, [6] and sleep survey from the Medical Outcomes Study ISSN (0): 2663-8290; ISSN (P): 2663-8282 Original Article