Reasons for underreporting of uraemic pruritus in people with chronic kidney disease: A qualitative study

Context Uraemic pruritus, or itch, is common in people with chronic kidney disease (CKD) and has a negative impact on their lives and well-being. However, for reasons currently unknown, itch often remains unreported and therefore untreated. Objectives To explore reasons for underreporting of itch in order to provide pointers for improving itch reporting and management in people with CKD. Methods We interviewed adult patients with CKD who self-reported experiencing itching in the last three years (n=25), nephrologists (n=10) and nurses (n=12) from three kidney services in the United Kingdom. Topic guides were informed by previous studies and a theoretical model of self-regulation. We conducted a thematic analysis of verbatim transcripts using Framework Analysis. Results
We identified three main themes reflecting factors that may influence whether itch is reported: knowledge on causes and treatment of itch (lack of awareness of the relationship between itch and CKD; lack of knowledge of treatment options); attitudes towards importance of itch as a health issue (patients’ attitudes; clinicians’ attitudes); and prompts for itch assessment during consultations (routine practice; itch as a marker; itch severity). Conclusions
Underreporting of itch is related to patients being unaware of its causes, accepting it as something to live with, prioritising other health issues, and the length and timing of consultations. Healthcare professionals’ assessment and management of itch vary widely and are not necessarily evidence-based. Better patient information, development of clinical practice guidelines, and incorporation of routine symptom assessments into care may improve itch reporting and management in people with CKD.