Novel approach to unpleasant symptom clusters surrounding pruritus in patients with chronic kidney disease and on dialysis therapy.
Novel approach to unpleasant symptom clusters surrounding pruritus in patients with chronic kidney disease and on dialysis therapy.
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DOI：
10.1097/mnh.0000000000000752
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发表时间：
2022-01-01
影响因子：
3.2
通讯作者：
Lockwood MB
中科院分区：
文献类型：
--
作者：
Ahdoot RS;Kalantar-Zadeh K;Burton JO;Lockwood MB
慢性肾脏病相关性瘙痒症（CKD-aP）是接受透析的终末期肾脏病（ESKD）患者的常见症状。CKD-aP通常与其他衰弱症状一起发生，可能包括所谓的“症状群”，其具有对患者健康相关生活质量（HRQoL）产生不利影响的协同效应。重要的是，集群中的症状可能具有共同的生物学机制。在这里，我们审查的CKD-aP的临床影响及其与透析患者报告的其他症状的关联。还讨论了治疗瘙痒症的临床获益及其对其他症状的潜在影响。研究表明，CKD-aP显著损害接受透析的ESKD患者的HRQoL，并与不良临床结局相关，包括感染、住院和死亡风险增加。尽管有这些负面影响，但CKD-aP在临床实践中仍然认识不足和治疗不足。CKD-aP通常与其他症状相关，包括睡眠障碍/睡眠质量差，焦虑，抑郁和疼痛。抗瘙痒治疗的临床研究表明，瘙痒强度的降低也可能减轻其他相关症状，如睡眠质量差。CKD-aP及其相关症状在临床实践中管理不足。更好地理解和认识透析患者的CKD-aP及其周围症状群可能会改善他们的整体症状管理和HRQoL。
Chronic kidney disease-associated-pruritus (CKD-aP) is a common symptom in patients with end-stage kidney disease (ESKD) undergoing dialysis. CKD-aP typically occurs alongside other debilitating symptoms and may comprise so-called ‘symptom clusters’ which have synergistic effects that adversely impact patient health-related quality of life (HRQoL). Importantly, symptoms in a cluster may share a common biological mechanism. Here we review the clinical impact of CKD-aP and its association with other symptoms reported by dialysis patients. The clinical benefits of treating pruritus and its potential impact on other symptoms are also addressed. Studies have shown CKD-aP significantly impairs HRQoL in patients with ESKD undergoing dialysis and is associated with adverse clinical outcomes, including increased risk of infections, hospitalizations, and mortality. Despite these negative effects, CKD-aP remains underrecognized and undertreated in clinical practice. CKD-aP is frequently associated with other symptoms, including disturbed sleep/poor sleep quality, anxiety, depression, and pain. Clinical studies of antipruritic therapies show that reduction of itch intensity may also alleviate other associated symptoms, such as poor sleep quality. CKD-aP and its associated symptoms are inadequately managed in clinical practice. Greater understanding and awareness of CKD-aP and its surrounding symptom clusters in dialysis patients may improve their overall symptom management and HRQoL.