Impact of Chronic Kidney Disease Severity on the Risk of Prurigo Nodularis: A Population-Based Cohort Study
Keywords:chronic kidney disease, severity, prurigo nodularis, risk, population-based, cohort study
While dialysis is linked with prurigo nodularis, little is known about the impact of non-dialysis chronic kidney disease on prurigo nodularis. The influence of chronic kidney disease on development of prurigo nodularis was measured using the Korean National Health Insurance and National Health Screening Program data, identifying 17,295,576 individuals without prior prurigo nodularis. Chronic kidney disease severity was determined by the estimated glomerular filtration rate (in ml/min/1.73 m2) calculated from serum creatinine, and proteinuria detected with urine dipstick. Prurigo nodularis incidence during follow-up was determined. Over a median follow-up period of 9.72 years, 58,599 individuals developed prurigo nodularis, with an incidence rate of 3.59 per 10,000 person-years. Among different variables, estimated glomerular filtration rate was the strongest risk factor for prurigo nodularis. Compared with estimated glomerular filtration rate ≥ 90, estimat-ed glomerular filtration rate 15–29 (hazard ratio 1.31, 95% confidence interval 1.05–1.62) and end-stage renal disease (hazard ratio 1.46, 95% confidence interval 1.25–1.69) were associated with higher risks. The presence of proteinuria independently increased the risk of prurigo nodularis, increased risks associated with estimated glomerular filtration rate 15–29 and end-stage renal disease, and caused risk associated with estimated glomerular filtration rate 30–59 to become significant. With differential impact of chronic kidney disease severity on the risk of prurigo nodularis, preservation of renal function would potentially translate into lower risk of prurigo nodularis.
Huang AH, Williams KA, Kwatra SG. Prurigo nodularis: epidemiology and clinical features. J Am Acad Dermatol 2020; 83: 1559-1565.
Zeidler C, Pereira MP, Augustin M, Spellman M, Ständer S. Investigator's global assessment of chronic prurigo: a new instrument for use in clinical trials. Acta Derm Venereol 2021; 101: adv00401.
Ryczek A, Reich A. Prevalence of prurigo nodularis in poland. Acta Derm Venereol 2020; 100: adv00155.
Augustin M, Garbe C, Hagenström K, Petersen J, Pereira MP, Ständer S. Prevalence, incidence and presence of comorbidities in patients with prurigo and pruritus in Germany: A population-based claims data analysis. J Eur Acad Dermatol Venereol 2021; 35: 2270-2276.
Kwatra SG. Breaking the Itch-scratch cycle in prurigo nodularis. N Engl J Med 2020; 382: 757-758.
Iking A, Grundmann S, Chatzigeorgakidis E, Phan NQ, Klein D, Ständer S. Prurigo as a symptom of atopic and non-atopic diseases: aetiological survey in a consecutive cohort of 108 patients. J Eur Acad Dermatol Venereol 2013; 27: 550-557.
Wikström K, Verkko H, Sinikumpu SP, Jokelainen J, Tasanen K, Huilaja L. Comorbidities of prurigo nodularis in Finland between 1996 and 2019. Acta Derm Venereol 2021; 101: adv00508.
Huang AH, Canner JK, Khanna R, Kang S, Kwatra SG. Real-world prevalence of prurigo nodularis and burden of associated diseases. J Invest Dermatol 2020; 140: 480-483.e4.
Böhme T, Heitkemper T, Mettang T, Phan NQ, Ständer S. Klinische Charakteristika und Prurigo nodularis bei nephrogenem Pruritus. Hautarzt 2014; 65: 714-720.
Hayani K, Weiss M, Weisshaar E. Clinical findings and provision of care in haemodialysis patients with chronic itch: new results from the German epidemiological haemodialysis itch study. Acta Derm Venereol 2016; 96: 361-366.
Levey AS, Grams ME, Inker LA. Uses of GFR and albuminuria level in acute and chronic kidney disease. N Engl J Med 2022; 386: 2120-2128.
Lee J, Lee JS, Park SH, Shin SA, Kim K. Cohort profile: The National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Int J Epidemiol 2017; 46: e15.
Lamb EJ, Tomson CR, Roderick PJ. Estimating kidney function in adults using formulae. Ann Clin Biochem 2005; 42: 321-345.
Choi HS, Han KD, Oh TR, Suh SH, Kim M, Kim CS, et al. Trends in the incidence and prevalence of end-stage renal disease with hemodialysis in entire Korean population: A nationwide population-based study. Medicine (Baltimore) 2021; 100: e25293.
Ständer S, Ketz M, Kossack N, Akumo D, Pignot M, Gabriel S, et al. Epidemiology of prurigo nodularis compared with psoriasis in Germany: a Claims Database analysis. Acta Derm Venereol 2020; 100: adv00309.
Zeidler C, Tsianakas A, Pereira M, Ständer H, Yosipovitch G, Ständer S. Chronic prurigo of nodular type: a review. Acta Derm Venereol 2018; 98: 173-179.
Boozalis E, Tang O, Patel S, Semenov YR, Pereira MP, Stander S, et al. Ethnic differences and comorbidities of 909 prurigo nodularis patients. J Am Acad Dermatol 2018; 79: 714-719.e3.
Ruggenenti P, Perna A, Gherardi G, Garini G, Zoccali C, Salvadori M, et al. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet 1999; 354: 359-364.
Williams KA, Huang AH, Belzberg M, Kwatra SG. Prurigo nodularis: pathogenesis and management. J Am Acad Dermatol 2020; 83: 1567-1575.
Misery L, Bodere C, Genestet S, Zagnoli F, Marcorelles P. Small-fibre neuropathies and skin: news and perspectives for dermatologists. Eur J Dermatol 2014; 24: 147-153.
Takaoka A, Arai I, Sugimoto M, Honma Y, Futaki N, Nakamura A, et al. Involvement of IL-31 on scratching behavior in NC/Nga mice with atopic-like dermatitis. Exp Dermatol 2006; 15: 161-167.
Sekine R, Satoh T, Takaoka A, Saeki K, Yokozeki H. Anti pruritic effects of topical crotamiton, capsaicin, and a corticosteroid on pruritogen-induced scratching behavior. Exp Dermatol 2012; 21: 201-204.
Jasti DB, Mallipeddi S, Apparao A, Vengamma B, Sivakumar V, Kolli S. A clinical and electrophysiological study of peripheral neuropathies in predialysis chronic kidney disease patients and relation of severity of peripheral neuropathy with degree of renal failure. J Neurosci Rural Pract 2017; 8: 516-524.
El-Moneim Shoeib M, El-Hamied Yassien H, El-Mohsen Montaser B, El-Hetamy R. Substance P: does it have a role in renal pruritus? Menoufia Med J 2021; 34: 472-476.
Choi JE, Di Nardo A. Skin neurogenic inflammation. Semin Immunopathol 2018; 40: 249-259.
Haas S, Capellino S, Phan NQ, Böhm M, Luger TA, Straub RH, et al. Low density of sympathetic nerve fibers relative to substance P-positive nerve fibers in lesional skin of chronic pruritus and prurigo nodularis. J Dermatol Sci 2010; 58: 193-197.
Huang AH, Canner JK, Kang S, Kwatra SG. Analysis of real-world treatment patterns in patients with prurigo nodularis. J Am Acad Dermatol 2020; 82: 34-36.
Stefaniak AA, Krajewski PK, Bednarska-Chabowska D, Bolanowski M, Mazur G, Szepietowski JC. Itch in adult population with type 2 diabetes mellitus: clinical profile, pathogenesis and disease-related burden in a cross-sectional study. Biology (Basel) 2021; 10: 1332.
Nakamura Y, Miyata M, Ohba T, Ando T, Hatsushika K, Suenaga F, et al. Cigarette smoke extract induces thymic stromal lymphopoietin expression, leading to T(H)2-type immune responses and airway inflammation. J Allergy Clin Immunol 2008; 122: 1208-1214.
Wilson SR, Thé L, Batia LM, Beattie K, Katibah GE, McClain SP, et al. The epithelial cell-derived atopic dermatitis cytokine TSLP activates neurons to induce itch. Cell 2013; 155: 285-295.
Clair C, Cohen MJ, Eichler F, Selby KJ, Rigotti NA. The effect of cigarette smoking on diabetic peripheral neuropathy: a systematic review and meta-analysis. J Gen Intern Med 2015; 30: 1193-1203.
Kazancioğlu R. Risk factors for chronic kidney disease: an update. Kidney Int Suppl (2011) 2013; 3: 368-371.
Martin CE, Clotet-Freixas S, Farragher JF, Hundemer GL. Have we just scratched the surface? A narrative review of uremic pruritus in 2020. Can J Kidney Health Dis 2020; 7: 2054358120954024.
Jedras M, Zakrzewska-Pniewska B, Gellert R, Debowska M, Wojtaszek E, Wardyn K. [Uremic neuropathy is more frequent in male patients]. Pol Arch Med Wewn 2001; 105: 391-398 (in Polish).
Cobo G, Hecking M, Port FK, Exner I, Lindholm B, Stenvinkel P, et al. Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis. Clin Sci (Lond) 2016; 130: 1147-1163.
How to Cite
Copyright (c) 2022 Hei Sung Kim, Hyun Jung Kim, Hyeong Sik Ahn
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.