Acta Dermato-Venereologica 99-4CompleteContent

423 INVESTIGATIVE REPORT Mortality of Haemodialysis Patients With and Without Chronic Itch: A Follow-up Study of the German Epidemiological Hemodialysis Itch Study (GEHIS) Katarzyna GROCHULSKA 1 , Robert OFENLOCH 1 , Thomas METTANG 2 and Elke WEISSHAAR 1 Department of Clinical Social Medicine, University Hospital Heidelberg, Heidelberg, and 2 Department of Nephrology, DKD Helios Clinic, Wiesbaden, Germany 1 The GEHIS (German Epidemiological Hemodialysis Itch Study) is a representative cohort study started in 2013 with 860 haemodialysis (HD) patients in 25 German dialysis units. Chronic itch (CI) has been reported to be a poor prognostic marker for patients on HD; how ever, this has not been investigated in a representative patient cohort. In 2017, all HD patients were contacted again to investigate mortality in those with and with out CI and to identify its determinants. Patients’ cha- racteristics, study instruments and CI were assessed, as in 2013. The response rate was 84.2% (n = 724). One-year mortality was 15.3%. Mortality was signifi- cantly higher in those with secondary scratch lesions compared with those with non-affected skin. This was also true after controlling for age and sex in a multiva- riate model. This study demonstrates a high mortality in HD patients; however, mortality depends on itch in- tensity, not on the occurrence of CI itself. Key words: epidemiology; GEHIS; haemodialysis; itch; morta- lity; pruritus; uraemic itch. Accepted Jan 23, 2019; E-published Jan 23, 2019 Acta Derm Venereol 2019; 99: 423–428. Corr: Elke Weisshaar, Department of Clinical Social Medicine, Occupa- tional and Environmental Dermatology, University Hospital Heidelberg, Voßstr. 2, DE-69115 Heidelberg, Germany. E-mail: elke.weisshaar@med. uni-heidelberg.de E nd-stage renal disease (ESRD)-associated itch, also called uraemic or renal itch, remains a challenge in daily clinical practice, in dermatology as well as in other fields of medicine. Due to lack of knowledge about the underlying pathophysiology of chronic itch (CI) in haemodialysis (HD), effective treatment modalities are lacking (1). To close this gap, we launched the German Epidemiological Hemodialysis Itch Study (GEHIS) in 2013 (2). In our first analyses, CI and associated factors were assessed using 3 different prevalence measures, showing that 25.2% (point prevalence) were affected by CI (2). Additional analyses of GEHIS investigated the role of, for example, haemodialysis characteristics and comorbidities (3), severity of CI and its clinical picture on the skin (4), health-related quality of life (HRQOL) (5) and the role of medications, such as loop diuretics (6). In 1991, it was reported for the first time that renal itch is an indicator of poor outcome, and later that the mor- SIGNIFICANCE The German Epidemiological Hemodialysis Itch Study in- vestigated chronic itch and associated factors in patients on haemodialysis. In 2013, 860 patients from 25 German dialysis units were included in the study. In 2017 the same haemodialysis patients were investigated again. During the observation period 48.1% of the haemodialysis pa- tients had died. Mortality was significantly higher in those with secondary scratch lesions compared with those with chronic itch in normal-looking skin, which means that those with scratch lesions on the skin were more prone to die. Chronic itch itself was not associated with earlier death. Dermatologists should pay close attention to haemodialysis patients with chronic itch who have severe scratch lesions on the skin. tality of HD patients may be influenced by the presence of itch (7–9). This appears to be influenced by sleep disturbance. Another study reported a 22% higher mor- tality rate in patients with moderate to extreme pruritus. A 2-fold increase in risk of mortality was shown in HD patients in the self-assessed “poor sleep” quality group compared with the “good sleep” group (10). However, in these studies severity and duration of itch were not clearly defined in terms of being, for example, acute or chronic (6 weeks and longer), or these studies were performed in non-representative patient populations. The aims of the follow-up study presented here were to report the mor- tality rate of HD patients with and without CI. Particular attention was paid to the presence and characteristics of CI and to the occurrence of sleep disturbances on the mortality of HD patients. MATERIALS AND METHODS German Epidemiological Hemodialysis Itch Study (GEHIS) GEHIS was designed as a prospective cohort study and all baseline data were assessed in 2013. The study design and demographic characteristics of the included patients have been reported in detail elsewhere (2). GEHIS includes 860 HD patients from 25 dialysis units, which were selected randomly from a cluster-sample reflecting the regional distribution of dialysis units throughout Ger- many. The follow-up study was approved by the ethics committee of the University of Heidelberg (S-670/2016) and conducted in accordance with the World Medical Association’s Declaration of This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3125 Acta Derm Venereol 2019; 99: 423–428

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