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Keywords:

  • depression;
  • longitudinal studies;
  • pruritus;
  • renal dialysis

Summary

Background  Recent reports suggest a cross-sectional association between psychiatric distress and pruritus in patients on haemodialysis (HD). However, no study has examined the likelihood of developing severe pruritus in patients on HD with depressive symptoms.

Objectives  To evaluate the relationship between baseline depressive symptoms and subsequent risk of developing severe pruritus.

Methods  A longitudinal study with a 0·5–2·5-year follow-up period was performed using 1799 patients on HD who had no/mild pruritus at baseline, based on the Japan Dialysis Outcomes and Practice Patterns Study (1996–2004), a cohort study composed of a representative sample of patients on HD. We assessed pruritus after the follow-up period using a self-reported questionnaire and depressive symptoms using scores from the five-item version of the Mental Health Inventory (MHI-5).

Results  The 1799 patients had a mean age of 56·9 years, 59·5% were men, and 23·6% presented depressive symptoms. Multivariable analysis revealed that patients with depressive symptoms had significantly higher odds of developing severe pruritus during the 0·5–2·5-year follow-up period [adjusted odds ratio (AOR) 1·57, 95% confidence interval 1·22–2·01, < 0·001]. In addition, a significant linear trend was observed between baseline MHI-5 scores and risk of developing severe pruritus, with AORs for third, second and first MHI-5 score quartiles of 1·08, 1·51 and 1·95, respectively (P for trend < 0·0001).

Conclusions  Our results suggest that depressive symptoms measured by MHI-5 may predict the future risk of developing severe pruritus in patients on HD.