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Importance <p>Chronic kidney disease–associated pruritus (CKD-aP) and depression are common but often underrecognized and undertreated in hemodialysis (HD) patients, lowering quality of life and worsening outcomes.</p> Objective <p>To evaluate whether the systematic, repeated collection of patient-reported outcome measures (PROMs) integrated into a Plan-Do-Act-Study (PDAS) framework could enhance recognition of CKD-aP and depression and guide treatment.</p> Design, setting, and participants <p>127 adult patients receiving thrice-weekly in-center HD were included. PROMs were captured electronically at predefined phases.</p> Interventions <p>During Adjustment phases, individualized symptom reports were reviewed by physicians, prompting initiation of difelikefalin for CKD-aP or referral to psychiatric care for depressive symptoms.</p> Main outcomes and measures <p>Changes in itch (Worst-Itch Numerical Rating Scale, WI-NRS) and depression (Patient Health Questionnaire-9, PHQ-9) and concordance between patients and nurses.</p> Results <p>At baseline, 32% of patients versus 9% of nurses reported pruritus (κ = 0.18) and 27% versus 6% reported depression (κ = 0.19). Following PROM-guided interventions, 16 patients initiated difelikefalin (median WI-NRS reduction of 3 points, <i>p</i> &lt; 0.001) and five were referred for psychiatric care (median PHQ-9 reduction of 4.5 points, <i>p</i> = 0.015). Patient–nurse agreement improved to κ = 0.66 for pruritus and κ = 0.65 for depression at study end. Ratings of assessment adequacy rose from 38% to 67% among patients and from 55% to 75% among nurses.</p> Conclusions and relevance <p>Routine, repeated PROMs markedly improved recognition of CKD-aP and depression, enabled targeted therapy with meaningful relief, and strengthened patient-staff alignment. This PDAS-based strategy supports KDIGO guidance and merits broader adoption to advance patient-centered dialysis care.</p>

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Reduction of pruritus and depression using longitudinal patient-reported outcome measures in hemodialysis: a quality improvement project

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月21日

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  • Luis Naar,
  • Sebastian Mussnig,
  • Janosch Niknam,
  • Florian Brosch,
  • Simon Krenn,
  • Christopher C. Mayer,
  • Joachim Beige,
  • Manfred Hecking

摘要

Importance

Chronic kidney disease–associated pruritus (CKD-aP) and depression are common but often underrecognized and undertreated in hemodialysis (HD) patients, lowering quality of life and worsening outcomes.

Objective

To evaluate whether the systematic, repeated collection of patient-reported outcome measures (PROMs) integrated into a Plan-Do-Act-Study (PDAS) framework could enhance recognition of CKD-aP and depression and guide treatment.

Design, setting, and participants

127 adult patients receiving thrice-weekly in-center HD were included. PROMs were captured electronically at predefined phases.

Interventions

During Adjustment phases, individualized symptom reports were reviewed by physicians, prompting initiation of difelikefalin for CKD-aP or referral to psychiatric care for depressive symptoms.

Main outcomes and measures

Changes in itch (Worst-Itch Numerical Rating Scale, WI-NRS) and depression (Patient Health Questionnaire-9, PHQ-9) and concordance between patients and nurses.

Results

At baseline, 32% of patients versus 9% of nurses reported pruritus (κ = 0.18) and 27% versus 6% reported depression (κ = 0.19). Following PROM-guided interventions, 16 patients initiated difelikefalin (median WI-NRS reduction of 3 points, p < 0.001) and five were referred for psychiatric care (median PHQ-9 reduction of 4.5 points, p = 0.015). Patient–nurse agreement improved to κ = 0.66 for pruritus and κ = 0.65 for depression at study end. Ratings of assessment adequacy rose from 38% to 67% among patients and from 55% to 75% among nurses.

Conclusions and relevance

Routine, repeated PROMs markedly improved recognition of CKD-aP and depression, enabled targeted therapy with meaningful relief, and strengthened patient-staff alignment. This PDAS-based strategy supports KDIGO guidance and merits broader adoption to advance patient-centered dialysis care.