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.