Improving the Reporting of Uraemic Pruritus in Dialysis Patients. KRUK

Uraemic pruritus, or itch, is a common symptom in dialysis patients, with prevalence estimates ranging from 25 to 42%. It is associated with a reduced quality of life, disturbed sleep, and an increased risk of depression and death. Dialysis patients have highlighted research into itching as a top priority. Effective treatment for uraemic pruritus is available. However, for reasons that are still largely unknown, many haemodialysis patients do not discuss their itch with the care team, potentially leaving uraemic pruritus untreated.

Wrist-worn accelerometers have been shown to accurately detect nocturnal scratching. As nocturnal scratching is a good indication of the presence of itch in general, this may provide a more objective assessment of uraemic pruritus to complement subjective patient reports, creating a more comprehensive clinical picture of the itch. This technology could therefore improve reporting of uraemic pruritus by enabling collection of objective, patient-generated data on scratching.

The overarching purpose of the proposed investigation is to take a first step towards improving the reporting of uraemic pruritus by introducing reports on objectively measured, nocturnal scratching activity. To achieve this, we will conduct interviews and focusgroups with patients and clinicians to explore reasons for underreporting of uraemic pruritus in dialysis patients, as well as ways to improve itch reporting. In addition, we will develop and evaluate a platform to support collection and processing of objective data on scratching captured directly from patients using accelerometers.

Successful completion of the project will advance our understanding of why itch is underreported, and will deliver a platform with the potential to improve this. In a future project, we will build on these results to further develop feedback reports to prompt conversations on itch between patients and the renal team, and evaluate the reports' effect on itch management, overall symptom burden, patient activation, and patient experience.