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Article

Prevalence, Factors, and Impact of CKD-aP on Quality of Life and Sleep in Indian Hemodialysis Patients: Cross-Sectional Study

by
Shreya Jain
,
Shankar Prasad Nagaraju
,
Priya Rani
,
Mohan Varadanayakanahalli Bhojaraja
*,
Shriya Narendra Shet Shirodkar
,
Attur Ravindra Prabhu
,
Dharshan Rangaswamy
,
Indu Ramachandra Rao
and
Srinivas Vinayak Shenoy
Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India
*
Author to whom correspondence should be addressed.
Kidney Dial. 2026, 6(2), 32; https://doi.org/10.3390/kidneydial6020032
Submission received: 7 February 2026 / Revised: 6 May 2026 / Accepted: 8 May 2026 / Published: 12 May 2026
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Abstract

Background: Chronic kidney disease-associated pruritus (CKD-aP) is characterised as pruritus in individuals with advanced chronic kidney disease (CKD) without a discernible alternative etiology. This study assessed the prevalence, severity, and effects of CKD-aP on sleep and health-related quality of life (HRQoL) among end-stage kidney disease patients (ESKD) undergoing maintenance hemodialysis (MHD) in an Indian cohort. Methods: This cross-sectional, single-centre study included adults with renal failure undergoing MHD for ≥3 months. The primary outcome was CKD-aP prevalence and its relationship with demographic, clinical, and laboratory variables. Secondary outcomes included CKD-aP severity, characteristics, HRQoL, and sleep quality scores. Statistical analysis was conducted using SPSS v21, with a significance level of p < 0.05. Results: The 12-item Pruritus Severity Scale found mild CKD-aP to be the most common (37% of patients). The 5-D Itch Scale found that patients with moderate-to-severe CKD-aP had longer daily itching (52.9%) with a nonsignificant change over time (p = 0.18), and the back (77.9%) was the most affected site. The Dermatology Life Quality Index revealed that 75.5% of patients had HRQoL impairment. The Skindex-16 found that moderate-to-severe CKD-aP was linked to a greater symptom burden and emotional distress. The Pittsburgh Sleep Quality Index found poorer sleep quality as CKD-aP worsened. Conclusions: CKD-aP is common in patients undergoing hemodialysis and negatively impacts quality of life, emphasizing the need for routine assessment and targeted management.

1. Introduction

Patients undergoing hemodialysis often complain of pruritus. It severely hinders daily functioning, social interactions, occupation, and sleep due to physical and mental health issues [1]. Recently, this condition has been renamed ‘CKD-associated pruritus’ (CKD-aP) from ‘uremic pruritus’ emphasizing that CKD-aP is complex and caused by more than high blood urea [2]. Histaminergic reactions, hyperparathyroidism, micro-inflammation, nociceptive sensory pathway changes, and opioid receptor dysfunction may cause CKD-aP [3]. CKD-aP is present at 18% to 98% prevalence, varying in severity [4,5,6]. Itching can occur before, during, or after dialysis sessions, and can be localized or generalized. CKD-aP can occur without skin changes or with xerosis; however, scratching can cause excoriations, ulcerations, and prurigo nodularis [7,8].
Assessing the severity of CKD-aP and its impact on quality of life is one of the biggest challenges after diagnosis, but ‘patient-reported outcomes (PROs)’ have been the only criteria [9], which have been categorized as ‘PREMs (Patient Reported Experience Measures)’ and ‘PROMs (Patient Reported Outcome Measures). ‘PREMs’ characterize a patient’s treatment experience or collective clinical satisfaction data. ‘PROMs’ like the 12-Item Pruritus Severity Scale (12-PSS) are standardised, quantitative questionnaires that assess a patient’s health. They assess age, functional status, treatment, mental health, quality of life, and disease-related response [10,11].
Several ‘PROM’ measures can be used to assess CKD-aP severity. Because they work best as screening tools, the primary unidimensional scales—the ‘visual analog scale (VAS), numerical rating scale (NRS),’ and ‘verbal numerical rating scale (VNRS)’—are rarely used in research. The ‘5-D Itch Scale’ and ‘Itch Severity Scale’ are two of the most used multi-dimensional pruritus measures in most CKD-aP studies [12,13,14,15,16].
HRQoL is used in clinical practice and research to evaluate the treatment of kidney disease. CKD-aP is difficult to manage because of its many symptoms and dermatological involvement. In most countries, it lowers ‘health-related quality of life (HRQoL)’ (Skindex 16 and ‘Dermatology Life Quality Index’(DLQI)) [17,18] and sleep (‘Pittsburgh Sleep Quality Index’ (PSQI)) [19]. We found a few Western studies but no Indian studies on the causes and effects of CKD-aP. Our study is the first to use standardised tools to examine the prevalence, clinical and laboratory factors, and impact on HRQoL and sleep in Indian hemodialysis patients.

2. Materials and Methods

2.1. Study Sample

A 3-month, cross-sectional, single-centre, time-bound observational trial at a tertiary care hospital in 2023 used convenience sampling to enroll eligible participants after obtaining written consent. All adults over 18 years with end-stage kidney disease (ESKD) on conventional maintenance hemodialysis (MHD) for more than three months were included. The dialysis adequacy was reported using kt/v. Patients on peritoneal dialysis, those with skin conditions other than uremic pruritus, acute kidney injury, and psychological or cognitive disorders that affected symptom reporting were excluded. The study population was divided into CKD-aP and non-CKD-aP groups based on their complaints during the first interview and the scores on the 12-PSS for data collection and analysis (Table 1).

2.2. Outcome Measures

The prevalence of CKD-aP and identification of clinical, dialysis-related, and biochemical factors associated with CKD-aP were the primary outcomes of this study. Secondary outcomes assessed the severity of CKD-aP (using the ‘12-item Pruritus Severity Scale’) and the characteristics (duration, direction, and distribution) of CKD-aP using the 5-D Itch Scale. The DLQI and Skindex-16 (symptoms, emotional impact, and functional impairment) were used to assess the impact on HRQoL, and the PSQI was used to assess the effect on sleep (Table 1).

2.3. Statistical Analysis

Frequency and percentage were used to represent categorical data, whereas mean ± standard deviation (SD) was used to represent continuous variables. The Chi-square test was used to assess categorical data, and the Kruskal–Wallis test or one-way ANOVA was used to compare groups. Statistical significance was set at less than 0.05. SPSS version 21.0 was used to analyze the data.
The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Ethics Committee) of Kasturba Medical College (IEC-33-2023, 8 June 2023).

3. Results

3.1. Primary Outcomes

  • Prevalence: In our study, 216 patients undergoing MHD were analyzed, of whom 60.6% (n = 131) experienced CKD-aP. The mean age of the pruritic population was 53.71 ± 13.6 years, and the majority were men (n = 102; 77.8%). Diabetic kidney disease (DKD) was the most common cause of ESKD (n = 48; 36.6%), and 11 patients (8.4%) were active smokers (Table 2).
  • Influence of clinical parameters: The CKD-aP and non-CKD-aP groups had similar highest percentages for each category in the baseline data analysis. In both groups, 64.89% and 64.7% of patients were 50–65 years old, respectively. The majority of the population were males (77.8% and 85.8%). A total of 36.6% and 35.2% of the respective groups had DKD, the most common cause of ESKD. Non-smokers dominated both groups (91.6% and 96.4%). None of these differences were statistically significant, suggesting no association between CKD-aP and clinical factors. Both groups had low rates of hepatitis C and B seropositivity, at 0.4% and 1.2%, respectively (Table 2).
  • Influence of dialysis-related factors: Dialysis-related factors did not differ between patients with and without CKD-aP. In both groups respectively, with 91.6% and 96.5% patients were on weekly-twice dialysis frequency. This suggests that both groups had similar dialysis frequencies and that CKD-aP was not associated with dialysis frequency (p = 0.09). Of the patients with CKD-aP, 67.9% had been on dialysis for less than five years, compared with 57.6% of the patients without CKD-aP. The proportion of patients with different dialysis durations was not statistically significant (p = 0.12) (Table 2).
  • Influence of lab parameters: There were no significant differences in the clinical parameters between the groups. The two groups had similar hemoglobin levels of 10.4 ± 2.1 g/dL and 10.6 ± 2.2 g/dL. Similar serum albumin levels were observed, with a mean of 4.3 ± 0.5 g/dL. The CKD-aP group had slightly higher serum phosphorus levels (5.81 ± 1.6 mg/dL) than the non-CKD-aP group (5.3 ± 1.7 mg/dL), but the difference was not statistically significant. Both groups had similar serum calcium levels of 8.1 ± 0.6 mg/dL. There were no significant differences in serum parathyroid hormone (PTH) levels, with a median of 990 [IQR 470–1480] pg/mL and 1008 [IQR 472.5–1488.1] (Table 2).
  • A multivariate analysis was conducted, but no variables were found to be independently associated with the outcome. The other variables did not reach significance after accounting for confounders.

3.2. Secondary Outcomes

  • Severity of pruritus by ‘12-Item Pruritus Severity Scale (12-PSS)’ (Figure 1): The CKD-aP severity assessed by the 12-PSS revealed that the largest proportion (37%) reported it to be mild, indicating that most patients experienced relatively low levels of discomfort. A smaller group (19.9%) reported moderate CKD-aP, while 3.7% of patients experienced severe CKD-aP, suggesting that a notable minority suffered from more intense symptoms. These findings underscore that, while a substantial number of patients were free from CKD-aP, the majority who reported CKD-aP had symptoms of mild to moderate severity, with a smaller subset experiencing more severe CKD-aP.
  • Characteristics of CKD-aP by 5-D Itch Scale: Patients with moderate-to-severe CKD-aP reported longer daily durations of itching. A higher percentage of patients in the moderate-to-severe group experienced CKD-aP for 12–18 h per day (52.9%) compared to 26.3% in the mild group. Conversely, a greater proportion of patients with mild CKD-aP reported having pruritus for less than 6 h a day (37.5%) compared to only 17.6% in the moderate-to-severe group (p = <0.001).
  • The direction variable, which reflects the concept of change over time, showed no significant difference between the mild and moderate-to-severe groups (p = 0.18). While a larger proportion of patients in both groups reported feeling ‘much better but still present’ (48.8% in the mild group vs. 35.3% in the moderate-to-severe group), there were no statistically significant differences in symptom resolution patterns between the two groups. Additionally, a small proportion of patients in both groups reported that their symptoms were ‘completely resolved’ or ‘unchanged.’
  • The analysis revealed a varied distribution of CKD-aP across multiple anatomical sites (Figure 2). The back emerged as the most affected area, with 77.9% of the participants reporting itching in this region. The head and scalp also showed a high prevalence of itching, with 64.9% of patients reporting discomfort in these areas. The chest and forearm areas followed closely, with 50.4% and 41.7% of patients experiencing CKD-aP, respectively. Other regions, such as the abdomen (36.6%), thighs (21.4%), and buttocks (17.6%), showed moderate prevalence rates of CKD-aP. The lower body, including the feet/toes (7.6%) and soles (19.8%), showed comparatively lower prevalence rates. Interestingly, the palms (13.7%) and groin (24.4%) areas also showed notable prevalence, with a significant proportion of participants reporting itching in these regions. The point of contact (25.2%) may reflect localized itching due to friction, pressure, or other external factors that are common in patients undergoing dialysis. Although the upper arms (75.6%) also showed a high rate of CKD-aP, the soles and palms showed moderate levels of itching.

3.3. Impact on ‘Health-Related Quality of Life (HRQoL)’

  • ‘Dermatology Life Quality Index (DLQI)’: Only 24.4% said their skin condition had ‘no effect’ on daily life. A total of 36.6% reported a ‘small effect’. A total of 38.9% reported a ‘moderate effect’ on quality of life. These findings showed that 75.5% of the participants had QoL impairment. The DLQI subscales revealed significant differences in quality of life between mild and moderate-to-severe CKD-aP. The Leisure subscale revealed that moderate-to-severe CKD-aP severity (mean = 3.07) had a more negative impact on leisure activities than mild severity (mean = 1.51). Moderate-to-severe CKD-aP (mean = 1.96) affected work and school more than mild CKD-aP (0.51). Moderate to severe CKD-aP disrupted relationships more than mild CKD-aP (mean = 1.41). Treatment for moderate to severe CKD-aP (mean = 2) requires more than mild treatment (0.46). In the Symptoms and Feelings subscale, moderate to severe CKD-aP (mean = 2.74) affected emotional well-being more than mild (1.63). The Daily Activities subscale revealed that moderate-to-severe CKD-aP (mean = 3.03) interfered more with daily life than mild CKD-aP (mean = 1.6).
  • Skindex 16: In the Symptoms subscale, mild CKD-aP had a median score of 14 (IQR = 9–23), whereas moderate-to-severe CKD-aP had a significantly higher median score of 46 (IQR = 38–52), (p < 0.001). Participants with mild CKD-aP had a median emotion subscale score of 18 (IQR = 9–24.7), whereas those with moderate-to-severe CKD-aP had a median score of 42 (IQR = 34–52), representing a significant difference (p < 0.001). Individuals with mild CKD-aP scored 17 on the function subscale (IQR = 7.2–25.7), while those with moderate to severe pruritus scored 51 (IQR = 43–55), a significant difference (p < 0.001).
  • Sleep disturbance assessment by ‘Pittsburgh Sleep Quality Index (PSQI)’: The participants were classified into two groups according to their PSQI score: poor sleep group (PSQI > 5) and good sleep group (PSQI ≤ 5). Most respondents with moderate-to-severe CKD-aP had a higher global PSQI score, with a median and interquartile range [IQR] of 8.00 (7–10); thus, higher scores were indicative of poor and impaired sleep quality.

4. Discussion

CKD-aP is a common complaint in patients undergoing hemodialysis. CKD-aP physically and mentally harms hemodialysis patients [20]. Chronic CKD-aP affects lifestyle, work, and sleep, causing emotional distress and lowering the quality of life. Hemodialysis patients’ CKD-aP prevalence, severity, and contributing factors are examined [21]. CKD-aP is common in patients on maintenance hemodialysis, with 60.6% of patients reporting CKD-aP. This supports previous studies that found 40–70% CKD-aP in patients undergoing hemodialysis. Patient demographics, dialysis modalities, and CKD-aP assessment methods may cause variability [6,22].
Most patients with CKD-aP and those without CKD-aP were aged 50–65 years. CKD-aP is common in older adults with CKD, supporting previous research suggesting age-related skin changes may increase risk [23]. A meta-analysis of 42 studies [24] of 11,800 adult dialysis patients found that younger patients had less severe CKD-aP in the ‘Dialysis Outcomes and Practice Patterns Study’ (DOPPS) [7,25].
Males dominated, with 77.8% of patients with pruritus and 85.8% without CKD-aP. Itching mechanisms, such as mast cell activation and opioid cannabinoid and neurokinin 1 system modulation, vary by gender [26], making this a research topic.
DKD caused ESKD in 36.6% of patients with CKD-aP and 35.2% of patients without CKD-aP. These findings suggest that DKD does not cause CKD-aP. Some studies have linked DKD and CKD-aP to poor glycemic control (high HbA1c). This suggests hyperglycemia-induced microvascular and neuropathic changes may cause CKD-aP, requiring further study [2,27,28].
Non-smokers comprised 91.6% of patients with CKD-aP and 96.4% of those without pruritus. Smoking worsens CKD. Some studies have linked smoking to CKD-aP, while others have not. This study found no statistically significant difference between smokers and non-smokers, suggesting that smoking may not cause CKD-aP. These findings support CKD-aPs’ multifactorial etiology and elusive pathophysiology [29,30].
This study examined the dialysis frequency and vintage. These factors had minimal impact on CKD-aP. Most patients with and without CKD-aP underwent twice-weekly dialysis (p = 0.09). This suggests that dialysis frequency does not cause CKD-aP in this cohort. Compared with 57.6% of non-CKD-aP patients, 67.9% had been on dialysis for less than five years. This was not significant (p = 0.12), suggesting that dialysis duration may not cause CKD-aP. Our study confirms the findings of Mathur et al.’s ITCH study [31], which found no link between itch and hemodialysis (HD) adequacy. Itching dialysis patients had a mean dialysis duration of 68.9 months, while non-itching patients had 50.8 months [32].
Hemoglobin, serum albumin, calcium, phosphorus, and PTH were CKD-aP-tested. Both CKD-aP and non-CKD-aP groups had similar parameters. Both groups had similar hemoglobin levels, with CKD-aP patients averaging 10.7 ± 2.1g/dL and non-CKD-aP patients 10.6 ± 2.2g/dL. Higher hemoglobin levels reduced moderate-to-severe itching in DOPPS 1, but not in further subsequent research [7,32]. Both groups had similar serum albumin levels, with CKD-aP patients averaging 4.4 ± 0.5 g/dL and non-CKD-aP patients having a similar average. Malnutrition and serum albumin did not affect CKD-aP in another study [33]. Hyperphosphatemia did not significantly aggravate CKD-aP, despite slightly higher blood phosphorus levels (5.8 ± 1.6 mg/dL) in the CKD-aP group compared to the non-CKD-aP group (5.3 ± 1.7 mg/dL). This study found no statistically significant difference, suggesting phosphorus’s role in CKD-aP needs further study. As in previous studies, serum calcium and PTH levels were similar between groups, suggesting calcium phosphate metabolism disturbances may not cause CKD-aP in this cohort [2,20,32].
The 12-PSS showed that most CKD-aP patients had mild to moderate symptoms. In those affected, 37% reported mild CKD-aP, 19.9% moderate, and 3.7% severe. These findings match Jeele et al. [34], who used 12-PSS to assess CKD-aP severity in 300 hemodialysis patients and found that 76.9% had moderate CKD-aP and 24.3% severe. Even though it may be less specific than the 5-D itch scale for itch distribution, the 12-PSS considers scratching extent and consequences.
The 5-D Itch Scale tracks duration, direction, and distribution. Daily itching duration increased CKD-aP severity. Serious CKD-aP itched daily. The difference between groups was significant (p < 0.001). Patients in both groups reported ‘completely resolved’ or ‘unchanged’. A symptom improvement direction variable did not differ between mild and moderate-to-severe groups (p = 0.18). The 5-D Itch Scale finds pruritus-prone skin on the back, scalp, and forearms. The complexity of CKD-aP in maintenance hemodialysis patients was shown by the lower prevalence of feet and palms. These findings emphasize targeted symptom management for the most common body regions and other important but less common ones. Ravindran et al. examined 42 consecutive maintenance hemodialysis patients and found that most had 6–12 h/day back, lower leg, thigh, head, and hand/finger discomfort [35].
This study examined CKD-aP’s HRQoL effects using the DLQI and Skindex 16. This study found that mild CKD-aP disrupts daily life. CKD-aP affects many aspects of life, regardless of severity, as there were statistically significant differences between mild and moderate pruritus groups. Leisure activities, social activities, housework, and work did not affect CKD-aP. However, the high proportion of hemodialysis patients reporting occasional or rare limitations in these areas suggests that CKD-aP may affect social and emotional well-being even without severe symptoms. Clinical CKD-aP treatment is essential because it reduces social engagement, work productivity, and quality of life. As in Mathur et al. [31] and Fishbane et al. [36], itching intensity was strongly associated with lower HRQoL in multiple domains.
This study linked CKD-aP severity to sleep disruption. Moderate-to-severe CKD-aP patients had significantly higher PSQI scores, indicating poorer sleep. Jeele et al. [34] found that severe CKD-aP can cause insomnia, frequent awakenings, and trouble falling asleep. A study of 300 hemodialysis patients found a mean PSQI score of 8.6 ± 5.8, with 61.9% (n = 185; 61.9%) being poor sleepers and 38.1% (n = 114; 38.1%) being good sleepers in dialysis patients, also CKD-aP-related sleep disruption can worsen fatigue, cognitive function, depression, and anxiety. The PSQI, with its longer recall period, may better capture sleep disruptions caused by CKD-aP. It assesses factors such as sleep duration, latency, and daytime dysfunction, which can also be influenced by comorbidities and psychological stress.
This study has some limitations. First, because it was a single-centre study done at a tertiary care hospital, the results may not be fully applicable to the larger Indian population of people on hemodialysis, especially those in different geographic areas, healthcare settings, or with different socioeconomic and clinical traits. Centre-specific factors, including patient selection, dialysis practices, and referral patterns, may have impacted the observed prevalence and associations. Moreover, data on current therapies were not recorded but these may have influence CKD-aP severity and HRQoL. Consequently, the findings must be interpreted judiciously when applied to alternative contexts. Subsequent multi-centre studies with more heterogeneous populations are necessary to confirm and broaden these results.

5. Conclusions

Two-thirds (60.6%) of the hemodialysis patients experienced CKD-associated pruritus, with mild CKD-aP (37%) being the most common. Demographic, clinical, dialysis-related, and biochemical factors did not show any significant correlation to CKD-aP in our hemodialysis population. Health-related quality of life and sleep quality worsened as CKD-aP severity increased, with sleep disturbances prevalent across severity levels. This highlights the substantial burden of CKD-aP on patients. Given these impacts, integrating symptom management strategies is crucial for advancing clinical care in hemodialysis patients.

Author Contributions

Conceptualization, M.V.B. and S.P.N.; methodology, M.V.B., S.P.N. and S.J.; validation, A.R.P., S.P.N., D.R., I.R.R. and S.V.S.; formal analysis, S.J. and P.R.; investigation, S.J.; data curation, S.J. and P.R.; writing—original draft preparation, M.V.B. and S.J.; writing—review and editing, M.V.B., P.R. and S.N.S.S.; visualization, S.J. and P.R.; supervision, M.V.B., A.R.P., D.R., I.R.R. and S.V.S. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Ethics Committee of Kasturba Medical College (IEC-33-2023, 8 June 2023).

Informed Consent Statement

Informed consent was obtained in writing from all subjects involved in the study.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author(s).

Acknowledgments

All of the authors have reviewed and edited the output and take full responsibility for the content of this publication.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
12-PSS12 Item Pruritus Severity Scale
ADPKDAutosomal Dominant Polycystic Kidney Disease
CGNChronic/Crescentic Glomerulonephritis
CKDaPChronic Kidney Disease-associated Pruritus
CTINChronic Tubulo-interstitial Nephritis
DKDDiabetic Kidney Disease
DLQIDermatology Life Quality Index
DOPPSDialysis Outcomes And Practice Patterns Study
ESKDEnd-stage Kidney Disease
HRQoLHealth-related Quality Of Life
IQRInter-quartile Range
MHDMaintenance Hemodialysis
NRSNumerical Rating Scale
PREMPatient-reported Experience Measure
PROPatient-reported Outcome
PROMPatient Reported Outcome Measure
PSQIPittsburgh Sleep Quality Index
PTHParathyroid Hormone
SDStandard Deviation
SPSSStatistical Package For Social Sciences
VASVisual Analogue Scale
VNRSVerbal Numerical Rating Scale

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Figure 1. Population distribution based on 12-PSS.
Figure 1. Population distribution based on 12-PSS.
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Figure 2. Pruritus site distribution using 5-D Itch Scale.
Figure 2. Pruritus site distribution using 5-D Itch Scale.
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Table 1. Assessment scales employed for symptom, sleep, and quality of life evaluation.
Table 1. Assessment scales employed for symptom, sleep, and quality of life evaluation.
S. No.Assessment CriteriaTool(s) UsedRangeJustification
1.Severity Scale for CKD-aP12-Item Pruritus Severity Scale (12-PSS)Total points: 22
No pruritus: 0–2; Mild: 3–6; Moderate: 7–11; Severe: 12–22		CKD-aP severity was quantified using patient-reported scores, enabling standardized severity classification (mild, moderate, severe) and tracking its consequences and extent. Essential for symptom evaluation in clinical practice and research settings.
2.Characteristics of CKD-aP5-D Itch ScaleTotal Points: 25
No itching: ≤8; Mild: 9–11; Moderate: 12–17; Severe: 18–21; Very severe: ≥22		It evaluates CKD-aP across five dimensions (duration, degree, direction, disability, and distribution), capturing the multidimensional aspects of itching and facilitating targeted symptom management strategies.
3.Sleep QualityPittsburgh Sleep Quality Index (PSQI)Total Points: 21
≤5: Good Sleep; >5: Degrading Sleep Quality 		Sleep quality and disturbance influenced by CKD-aP severity were assessed, with scores directly reflecting sleep disruption. Key for linking pruritus with sleep outcomes in patients with CKD.
4.Quality of LifeDermatology Life Quality Index (DLQI)Total Points: 30
0–1: No effect; 2–5: Small effect; 6–10: Moderate effect; 11–20: Very large effect; 21–30: Extremely large effect		It measures dermatological QoL impairment across diverse daily life domains, highlighting the significant impact of CKD-aP on daily living, leisure, work, relationships, and emotional well-being.
5.Skindex 16Symptoms: Mild (median score ~14 [IQR 9–23]), Moderate to Severe (median score ~46 [IQR 38–52]); Emotions: Mild (median score ~18 [IQR 9–24.7]), Moderate to Severe (median score ~42 [IQR 34–52]);
Function: Mild (median score ~17 [IQR 7.2–25.7]), Moderate to Severe (median score ~51 [IQR 43–55])		It provides a validated, sensitive measure of skin-related QoL, capturing the physical, emotional, and functional impairment caused by CKD-aP.
Table 2. Influence of clinical, dialysis-related and biochemical factors on CKD-aP.
Table 2. Influence of clinical, dialysis-related and biochemical factors on CKD-aP.
Demographic VariablesTotal
(n = 216)		CKD-aP
(n = 131)		No CKD-aP
(n = 85)		p-Value
Age (years) (Mean ± SD)53.4 ± 13.253.7 ± 13.653.0 ± 12.80.70
Males (n, %) *175 (81.0)102 (77.8)73 (85.8)0.14
Etiology of CKD (n, %) *
ADPKD8 (3.7)6 (4.5)2 (2.3)0.66
CGN53 (24.5)29 (22.1)24 (28.2)
CTIN77 (35.6)48 (36.6)29 (34.1)
DKD78 (36.1)48 (36.6)30 (35.2)
Lifestyle
Current smokers (n, %) *13 (6.0)11 (8.4)3 (3.5)0.15
Dialysis Characteristics (n, %)
Hemodialysis Frequency (per week) *Once1 (0.4)01 (1.2)0.09
Twice202 (93.5)120 (91.6)82 (96.5)
Thrice13 (6.0)11 (8.3)2 (2.4)
Dialysis Vintage *<5 years138 (63.8)89 (67.9)49 (57.6)0.12
>5 years78 (36.1)42 (32.0)36 (42.4)
Laboratory Parameters
Hemoglobin (g/dL) (Mean ± SD)10.6 ± 2.210.4 ± 2.19.7 ± 2.00.80
S. Albumin (g/dL) (Mean ± SD)4.3 ± 0.564.3 ± 0.574.3 ± 0.550.38
S. Phosphorous (mg/dL) (Mean ± SD) units5.3 ± 1.65.5 ± 1.65.1 ± 1.60.07
S. Calcium (mg/dL) (Mean ± SD)8.1 ± 0.68.1 ± 0.68.1 ± 0.60.72
S. Parathormone (pg/mL) (Median, IQR)1008 (472.5, 1488.1)1020 (500, 1490)990 (470, 1480)0.72
Hepatitis C (n, %) *1 (0.4)1 (1.2)00.43
Hepatitis B (n, %) *1 (0.4)1 (1.2)0
Data are shown as mean ± standard deviation (SD), median [interquartile range (IQR)] or number (percentage); * Indicates categorical variables analyzed using the chi-square test.
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Jain, S.; Nagaraju, S.P.; Rani, P.; Bhojaraja, M.V.; Shirodkar, S.N.S.; Prabhu, A.R.; Rangaswamy, D.; Rao, I.R.; Shenoy, S.V. Prevalence, Factors, and Impact of CKD-aP on Quality of Life and Sleep in Indian Hemodialysis Patients: Cross-Sectional Study. Kidney Dial. 2026, 6, 32. https://doi.org/10.3390/kidneydial6020032

AMA Style

Jain S, Nagaraju SP, Rani P, Bhojaraja MV, Shirodkar SNS, Prabhu AR, Rangaswamy D, Rao IR, Shenoy SV. Prevalence, Factors, and Impact of CKD-aP on Quality of Life and Sleep in Indian Hemodialysis Patients: Cross-Sectional Study. Kidney and Dialysis. 2026; 6(2):32. https://doi.org/10.3390/kidneydial6020032

Chicago/Turabian Style

Jain, Shreya, Shankar Prasad Nagaraju, Priya Rani, Mohan Varadanayakanahalli Bhojaraja, Shriya Narendra Shet Shirodkar, Attur Ravindra Prabhu, Dharshan Rangaswamy, Indu Ramachandra Rao, and Srinivas Vinayak Shenoy. 2026. "Prevalence, Factors, and Impact of CKD-aP on Quality of Life and Sleep in Indian Hemodialysis Patients: Cross-Sectional Study" Kidney and Dialysis 6, no. 2: 32. https://doi.org/10.3390/kidneydial6020032

APA Style

Jain, S., Nagaraju, S. P., Rani, P., Bhojaraja, M. V., Shirodkar, S. N. S., Prabhu, A. R., Rangaswamy, D., Rao, I. R., & Shenoy, S. V. (2026). Prevalence, Factors, and Impact of CKD-aP on Quality of Life and Sleep in Indian Hemodialysis Patients: Cross-Sectional Study. Kidney and Dialysis, 6(2), 32. https://doi.org/10.3390/kidneydial6020032

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