Relationship Between Standardized Measures of Chronic Kidney Disease-associated Pruritus Intensity and Health-related Quality of Life Measured with the EQ-5D Questionnaire: A Mapping Study
DOI:
https://doi.org/10.2340/actadv.v103.11604Keywords:
Chronic Kidney Disease, Health Related Quality of Life, PruritusAbstract
Chronic kidney disease-associated pruritus is linked with decreased health-related quality of life assessed using disease-specific instruments. The extent to which worsening pruritus reduces generic quality of life assessed using the EQ-5D instrument is unknown. Prevalent kidney failure patients receiving in-centre haemodialysis from 5 centres completed the EQ-5D-5L quality of life measure, worst Itching Intensity Numerical Rating Scale and 5-D itch pruritus instruments. Latent class models were used to identify clusters of patients with similarly affected body parts, and mixture models were used to map the pruritus measures to the EQ-5D. Data on 487 respondents were obtained. Latent class analysis identified 3 groups of patients who had progressively worsening severity and an increasing number of body parts affected. Although the worst itching intensity numerical rating scale and 5-D itch instruments correlated with each other, only the latter had a strong relationship with EQ-5D. When controlling for age, sex, diabetes and years receiving dialysis, the meanpredicted EQ-5D utility (1: perfect health, 0: dead) decreased progressively from 0.69 to 0.41. These findings suggest that pruritus instruments that include domains capturing how the individual is physically, mentally and socially affected by their pruritus, in addition to severity, more closely approximate the EQ-5D generic quality of life measure.
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References
Swarna SS, Aziz K, Zubair T, Qadir N, Khan M. Pruritus associated with chronic kidney disease: a comprehensive literature review. Cureus 2019; 11: e5256.
https://doi.org/10.7759/cureus.5256 DOI: https://doi.org/10.7759/cureus.5256
Sukul N, Karaboyas A, Csomor PA, Schaufler T, Wen W, Menzaghi F, et al. Self-reported pruritus and clinical, dialysis-related, and patient-reported outcomes in hemodialysis patients. Kidney Med 2021; 3: 42-53.e41.
https://doi.org/10.1016/j.xkme.2020.08.011 DOI: https://doi.org/10.1016/j.xkme.2020.08.011
Rayner HC, Larkina M, Wang M, Graham-Brown M, van der Veer SN, Ecder T, et al. International comparisons of prevalence, awareness, and treatment of pruritus in people on hemodialysis. Clin J Am Soc Nephrol 2017; 12: 2000-2007.
https://doi.org/10.2215/CJN.03280317 DOI: https://doi.org/10.2215/CJN.03280317
Pisoni RL, Wikström B, Elder SJ, Akizawa T, Asano Y, Keen ML, et al. Pruritus in haemodialysis patients: international results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2006; 21: 3495-3505.
https://doi.org/10.1093/ndt/gfl461 DOI: https://doi.org/10.1093/ndt/gfl461
Poku E, Harnan S, Rooney G, James MM, Hernández-Alava M, Schaufler T, et al. The relationship between chronic kidney disease-associated pruritus and health-related quality of life: a systematic review. Clin Kidney J 2022; 15: 484-499.
https://doi.org/10.1093/ckj/sfab218 DOI: https://doi.org/10.1093/ckj/sfab218
Manns B, Hemmelgarn B, Lillie E, Dip SC, Cyr A, Gladish M, et al. Setting research priorities for patients on or nearing dialysis. Clin J Am Soc Nephrol 2014; 9: 1813-1821.
https://doi.org/10.2215/CJN.01610214 DOI: https://doi.org/10.2215/CJN.01610214
Lipman ZM, Paramasivam V, Yosipovitch G, Germain MJ. Clinical management of chronic kidney disease-associated pruritus: current treatment options and future approaches. Clin Kidney J 2021; 14: i16-i22.
https://doi.org/10.1093/ckj/sfab167 DOI: https://doi.org/10.1093/ckj/sfab167
Millington GWM, Collins A, Lovell CR, Leslie TA, Yong ASW, Morgan JD, et al. British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018. Br J Dermatol 2018; 178: 34-60. DOI: https://doi.org/10.1111/bjd.16186
https://doi.org/10.1111/bjd.16117 DOI: https://doi.org/10.1111/bjd.16117
Ständer S, Zeidler C, Augustin M, Darsow U, Kremer AE, Legat SK, et al. Diagnostik und Therapie des chronischen Pruritus. S2k-LL AWMF-Register 2017; 13: 048.
Naegeli AN, Flood E, Tucker J, Devlen J, Edson-Heredia E. The Worst Itch Numeric Rating Scale for patients with moderate to severe plaque psoriasis or psoriatic arthritis. Int J Dermatol 2015; 54: 715-722.
https://doi.org/10.1111/ijd.12645 DOI: https://doi.org/10.1111/ijd.12645
Elman S, Hynan LS, Gabriel V, Mayo MJ. The 5-D itch scale: a new measure of pruritus. Br J Dermatol 2010; 162: 587-593.
https://doi.org/10.1111/j.1365-2133.2009.09586.x DOI: https://doi.org/10.1111/j.1365-2133.2009.09586.x
Mathur VS, Lindberg J, Germain M, Block G, Tumlin J, Smith M, et al. A longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol 2010; 5: 1410-1419.
https://doi.org/10.2215/CJN.00100110 DOI: https://doi.org/10.2215/CJN.00100110
Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011; 20: 1727-1736.
https://doi.org/10.1007/s11136-011-9903-x DOI: https://doi.org/10.1007/s11136-011-9903-x
Hernández Alava M, Wailoo A, Wolfe F, Michaud K. A comparison of direct and indirect methods for the estimation of health utilities from clinical outcomes. Med Decis Making 2014; 34: 919-930.
https://doi.org/10.1177/0272989X13500720 DOI: https://doi.org/10.1177/0272989X13500720
Heinz KC, Willems D, Hiligsmann M. Economic evaluation of a JAK inhibitor compared to a monoclonal antibody for treatment of moderate-to-severe atopic dermatitis from a UK perspective. J Med Econ 2022; 25: 491-502.
https://doi.org/10.1080/13696998.2022.2059220 DOI: https://doi.org/10.1080/13696998.2022.2059220
Thokala P, Hnynn Si PE, Hernandez Alava M, Sasso A, Schaufler T, Soro M, et al. Cost effectiveness of difelikefalin compared to standard care for treating chronic kidney disease associated pruritus (CKD-aP) in people with kidney failure receiving haemodialysis. Pharmacoeconomics 2023; 41: 457-466.
https://doi.org/10.1007/s40273-022-01237-4 DOI: https://doi.org/10.1007/s40273-022-01237-4
Whang KA, Khanna R, Williams KA, Mahadevan V, Semenov Y, Kwatra SG. Health-related QOL and economic burden of chronic pruritus. J Invest Dermatol 2021; 141: 754-760.e1.
https://doi.org/10.1016/j.jid.2020.08.020 DOI: https://doi.org/10.1016/j.jid.2020.08.020
Ständer S, Augustin M, Reich A, Blome C, Ebata T, Phan NQ, et al. Pruritus assessment in clinical trials: consensus recommendations from the International Forum for the Study of Itch (IFSI) Special Interest Group Scoring Itch in Clinical Trials. Acta Derm Venereol 2013; 93: 509-514.
https://doi.org/10.2340/00015555-1620 DOI: https://doi.org/10.2340/00015555-1620
Reich A, Heisig M, Phan NQ, Taneda K, Takamori K, Takeuchi S, et al. Visual analogue scale: evaluation of the instrument for the assessment of pruritus. Acta Derm Venereol 2012; 92: 497-501.
https://doi.org/10.2340/00015555-1265 DOI: https://doi.org/10.2340/00015555-1265
Lopes MB, Karaboyas A, Sukul N, Tsuruya K, Al Salmi I, Asgari E, et al. Utility of a single itch-related question and the Skindex-10 questionnaire for assessing pruritus and predicting health-related quality of life in patients receiving hemodialysis. Kidney Med 2022; 4: 100476.
https://doi.org/10.1016/j.xkme.2022.100476 DOI: https://doi.org/10.1016/j.xkme.2022.100476
Hernandez Alava M, Pudney S, Wailoo A. The EQ-5D-5L value set for England: findings of a quality assurance program. Value Health 2020; 23: 642-648.
https://doi.org/10.1016/j.jval.2019.10.017 DOI: https://doi.org/10.1016/j.jval.2019.10.017
Fotheringham J, Barnes T, Dunn L, Lee S, Ariss S, Young T, et al. A breakthrough series collaborative to increase patient participation with hemodialysis tasks: a stepped wedge cluster randomised controlled trial. PLoS One 2021; 16: e0253966.
https://doi.org/10.1371/journal.pone.0253966 DOI: https://doi.org/10.1371/journal.pone.0253966
Wailoo AJ, Hernandez-Alava M, Manca A, Mejia A, Ray J, Crawford B, et al. Mapping to estimate health-state utility from non-preference-based outcome measures: an ISPOR good practices for outcomes research task force report. Value Health 2017; 20: 18-27.
https://doi.org/10.1016/j.jval.2016.11.006 DOI: https://doi.org/10.1016/j.jval.2016.11.006
van Hout B, Janssen MF, Feng YS, Kohlmann T, Busschbach J, Golicki D, et al. Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Health 2012; 15: 708-715.
https://doi.org/10.1016/j.jval.2012.02.008 DOI: https://doi.org/10.1016/j.jval.2012.02.008
National Institute for H, Care E. NICE process and methods guides. Guide to the Methods of Technology Appraisal 2013. London: National Institute for Health and Care Excellence (NICE); 2013.
Dawoud D, Lamb A, Moore A, Bregman C, Rupniewska E, Paling T, et al. Capturing what matters: updating NICE methods guidance on measuring and valuing health. Qual Life Res 2022; 31: 2167-2173.
https://doi.org/10.1007/s11136-022-03101-6 DOI: https://doi.org/10.1007/s11136-022-03101-6
Hernández Alava M, Wailoo A, Pudney S, Gray L, Manca A. Mapping clinical outcomes to generic preference-based outcome measures: development and comparison of methods. Health Technol Assess 2020; 24: 1-68.
https://doi.org/10.3310/hta24340 DOI: https://doi.org/10.3310/hta24340
Hernández Alava M, Wailoo AJ, Ara R. Tails from the peak district: adjusted limited dependent variable mixture models of EQ-5d questionnaire health state utility values. Value Health 2012; 15: 550-561.
https://doi.org/10.1016/j.jval.2011.12.014 DOI: https://doi.org/10.1016/j.jval.2011.12.014
Alava MH, Wailoo A. Fitting adjusted limited dependent variable mixture models to EQ-5D. Stata J 2015; 15: 737-750.
https://doi.org/10.1177/1536867X1501500307 DOI: https://doi.org/10.1177/1536867X1501500307
Phan NQ, Blome C, Fritz F, Gerss J, Reich A, Ebata T, et al. Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus. Acta Derm Venereol 2012; 92: 502-507.
https://doi.org/10.2340/00015555-1246 DOI: https://doi.org/10.2340/00015555-1246
Weiner DE, Vervloet MG, Walpen S, Schaufler T, Munera C, Menzaghi F, et al. Safety and effectiveness of difelikefalin in patients with moderate-to-severe pruritus undergoing hemodialysis: an open-label, multicenter study. Kidney Med 2022; 4: 100542.
https://doi.org/10.1016/j.xkme.2022.100542 DOI: https://doi.org/10.1016/j.xkme.2022.100542
Cooper JT, Lloyd A, Sanchez JJG, Sörstadius E, Briggs A, McFarlane P. Health related quality of life utility weights for economic evaluation through different stages of chronic kidney disease: a systematic literature review. Health Qual Life Outcomes 2020; 18: 310.
https://doi.org/10.1186/s12955-020-01559-x DOI: https://doi.org/10.1186/s12955-020-01559-x
Wang C-C, Tang C-H, Huang K-C, Huang S-Y, Sue Y-M. Increased risk of incident psoriasis in end-stage renal disease patients on chronic hemodialysis: a nationwide population-based cohort study. J Dermatol 2018; 45: 1063-1070.
https://doi.org/10.1111/1346-8138.14531 DOI: https://doi.org/10.1111/1346-8138.14531
Masmoudi A, Hajjaji Darouiche M, Ben Salah H, Ben Hmida M, Turki H. Cutaneous abnormalities in patients with end stage renal failure on chronic hemodialysis. A study of 458 patients. J Dermatol Case Rep 2014; 8: 86-94.
https://doi.org/10.3315/jdcr.2014.1182 DOI: https://doi.org/10.3315/jdcr.2014.1182
Brown EA, Zhao J, McCullough K, Fuller DS, Figueiredo AE, Bieber B, et al. Burden of kidney disease, health-related quality of life, and employment among patients receiving peritoneal dialysis and in-center hemodialysis: findings from the DOPPS Program. Am J Kidney Dis 2021; 78: 489-500.e1.
https://doi.org/10.1053/j.ajkd.2021.02.327 DOI: https://doi.org/10.1053/j.ajkd.2021.02.327
Agarwal R, Burton J, Gallieni M, Kalantar-Zadeh K, Mayer G, Pollock C, et al. Alleviating symptoms in patients undergoing long-term hemodialysis: a focus on chronic kidney disease-associated pruritus. Clin Kidney J 2022; 16: 30-40.
https://doi.org/10.1093/ckj/sfac187 DOI: https://doi.org/10.1093/ckj/sfac187
Smyth B, van den Broek-Best O, Hong D, Howard K, Rogers K, Zuo L, et al. Varying association of extended hours dialysis with quality of life. Clin J Am Soc Nephrol 2019; 14: 1751-1762.
https://doi.org/10.2215/CJN.06800619 DOI: https://doi.org/10.2215/CJN.06800619
Evangelidis N, Tong A, Manns B, Hemmelgarn B, Wheeler DC, Tugwell P, et al. Developing a set of core outcomes for trials in hemodialysis: an international delphi survey. Am J Kidney Dis 2017; 70: 464-475.
https://doi.org/10.1053/j.ajkd.2016.11.029 DOI: https://doi.org/10.1053/j.ajkd.2016.11.029
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