BALANCING EFFICACY AND RESOURCE USE: A PRAGMATIC APPROACH TO PRURITUS MANAGEMENT IN DIALYSIS PATIENTS IN US DIALYSIS ORGANIZATION
Author(s)
James Fotheringham, MD, PhD1, Steven Fishbane, MD, PhD2, Hans-Juergen Arens, PhD3, Maria Gil Mir, PhD3, Marco Soro, PharmD4.
1University of Sheffield, Sheffield, United Kingdom, 2Department of Medicine, Northwell Health, Great Neck, Hempstead, NY, USA, 3Frenova, Fresenius Medical Care, Bad Homburg, Germany, 4Global Value, Access & Policy, CSL Vifor, Rome, Italy.
1University of Sheffield, Sheffield, United Kingdom, 2Department of Medicine, Northwell Health, Great Neck, Hempstead, NY, USA, 3Frenova, Fresenius Medical Care, Bad Homburg, Germany, 4Global Value, Access & Policy, CSL Vifor, Rome, Italy.
OBJECTIVES: Chronic kidney disease-associated pruritus (CKD-aP) is a debilitating and often underrecognized condition in hemodialysis patients. This analysis compared real-world pharmacologic management strategies, including no treatment, within a large US dialysis organization.
METHODS: This retrospective study included hemodialysis patients from Fresenius Medical Care clinics in the US with baseline Worst Itch Numeric Rating Scale (WI-NRS) ≥4 and at least one follow-up WI-NRS assessment after treatment initiation. Four groups were analyzed: DFK (n=173), receiving difelikefalin continuously for ≥9 weeks or with gaps ≤2 weeks; DFK-Gap (n=453), receiving DFK for ≥9 weeks followed by a gap >2 weeks; Untreated-Control (n=60 propensity score-matched patients with DFK) not receiving DFK or other anti-pruritus drugs at baseline; and Treated-Control (n=422), receiving non-DFK anti-pruritus therapies. Outcomes from baseline to 6 months included WI-NRS change, dialysis adherence, laboratory parameters, medication use, and infection-related hospitalizations and length of stay.
RESULTS: At follow-up DFK-group showed the greatest pruritus improvement, with 50.3% of patients achieving a ≥3-point WI-NRS reduction versus 40.2% in DFK-Gap, 38.3% in Untreated-Control, and 37.5% in Treated-Control. DFK was also associated with improvements in serum albumin, hemoglobin, and phosphorus, while dialysis adequacy (Kt/V) remained stable. In multivariate analysis, DFK had the lowest infection-related hospitalization burden, with a post-baseline incidence rate of 0.08 per patient-year. Compared with DFK, rate ratios were higher for DFK-Gap (1.50 [1.43-1.57]), Untreated-Control (1.22 [1.13-1.31]), and Treated-Control (1.48 [1.42-1.55]); all p<0.0001.
CONCLUSIONS: Sustained DFK therapy was associated with greater CKD-aP symptom improvement, favorable changes in selected nutritional and hematologic markers, lower infection-related hospitalization burden, and preserved dialysis adequacy. These findings suggest that continuous DFK treatment may support better clinical outcomes and reduced healthcare resource use in hemodialysis patients with CKD-aP.
METHODS: This retrospective study included hemodialysis patients from Fresenius Medical Care clinics in the US with baseline Worst Itch Numeric Rating Scale (WI-NRS) ≥4 and at least one follow-up WI-NRS assessment after treatment initiation. Four groups were analyzed: DFK (n=173), receiving difelikefalin continuously for ≥9 weeks or with gaps ≤2 weeks; DFK-Gap (n=453), receiving DFK for ≥9 weeks followed by a gap >2 weeks; Untreated-Control (n=60 propensity score-matched patients with DFK) not receiving DFK or other anti-pruritus drugs at baseline; and Treated-Control (n=422), receiving non-DFK anti-pruritus therapies. Outcomes from baseline to 6 months included WI-NRS change, dialysis adherence, laboratory parameters, medication use, and infection-related hospitalizations and length of stay.
RESULTS: At follow-up DFK-group showed the greatest pruritus improvement, with 50.3% of patients achieving a ≥3-point WI-NRS reduction versus 40.2% in DFK-Gap, 38.3% in Untreated-Control, and 37.5% in Treated-Control. DFK was also associated with improvements in serum albumin, hemoglobin, and phosphorus, while dialysis adequacy (Kt/V) remained stable. In multivariate analysis, DFK had the lowest infection-related hospitalization burden, with a post-baseline incidence rate of 0.08 per patient-year. Compared with DFK, rate ratios were higher for DFK-Gap (1.50 [1.43-1.57]), Untreated-Control (1.22 [1.13-1.31]), and Treated-Control (1.48 [1.42-1.55]); all p<0.0001.
CONCLUSIONS: Sustained DFK therapy was associated with greater CKD-aP symptom improvement, favorable changes in selected nutritional and hematologic markers, lower infection-related hospitalization burden, and preserved dialysis adequacy. These findings suggest that continuous DFK treatment may support better clinical outcomes and reduced healthcare resource use in hemodialysis patients with CKD-aP.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD150
Topic
Clinical Outcomes, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Urinary/Kidney Disorders