OBJECTIVES: A significant proportion of patients with chronic kidney disease (CKD) on hemodialysis (HD) suffer from a condition referred as CKD-associated pruritus (CKD-aP). This pruritus is associated with a significant reduction in health-related quality of life (HRQoL) and leads to an increased economic burden. We aimed to determine the prevalence of CKD-aP and to compare its burden and healthcare resource utilization between groups with CKD receiving HD with/without pruritus analyzing German administrative claims.

METHODS: A large database of insurance data was used to identify groups with CKD receiving HD who were either diagnosed with pruritus or not. As there is no unique code for CKD-aP, we applied all relevant ICD-10-GM codes included in a German S2k-guideline. Patients with CKD-aP were identified by ICD-10-GM codes L28.-, L29.-, L98.1 and F45.8. Comparability between groups was ensured by a standardized mean difference <0.1 with respect to the covariates age and sex. Comorbidities for both groups were analyzed over a one-year period and assessed using odds ratios (OR).

RESULTS: A total of 273 patients with CKD-aP and 3,076 patients without a pruritus diagnosis were identified. CKD-aP patients represented 6.3% of all identified CKD patients with long-term HD. Relevant comorbidities such as dermatitis (OR=4.0), depression (OR=1.9), insomnia (OR=1.7), and polyneuropathy (OR=1.7) were significantly more common in patients with CKD-aP than in patients without (23.8% vs. 7.3%, 33.3% vs. 21.0%, 17.2% vs. 10.7%, 38.1% vs. 26.9%, all p<0.01).

CONCLUSIONS: HD patients with CKD-aP had a significantly higher comorbidity burden than those without CKD-aP. Comparing the prevalence of this study of 6.3% with the current literature, which estimates the prevalence at 27.0%, it is clear that the accurate diagnosis and adequate treatment of CKD-aP is difficult. This highlights the importance of increase CKD-aP detection and having a unique CKD-aP code in the new ICD-11 catalog.