Older age, higher body mass index (BMI), and current smoking are among the risk factors for moderate to severe pruritus in patients with nondialysis chronic kidney disease (CKD), according to a recently published study.

In a study of 1951 participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) who did not have pruritus at baseline, moderate to severe pruritus — defined as a response of 3 or higher on a Likert scale of 1 to 5 — developed in 660 patients (34%) over a median follow-up duration of 6 years, Kendra Wulczyn, MD, of the nephrology division at Massachusetts General Hospital in Boston, and colleagues reported in the Clinical Journal of the American Society of Nephrology.

Patients aged 65 years or older had a 31% increased risk for moderate to severe pruritus compared with those aged 44 to 64 years, according to the investigators. Each 5 kg/m2 increase in BMI was associated with a 10% increased risk. Current smokers had a 60% increased risk compared with patients who were not current smokers. Opioid use was associated with a 27% increased risk for moderate to severe pruritus compared with nonuse. Patients with moderate depressive symptoms had a 46% increased risk compared with those who had no depressive symptoms. An iPTH level of 65 pg/mL or higher was associated with a 30% increased risk compared with lower levels. All of these increased risks were statistically significant.

Patients with a serum calcium level less than 9 mg/dL had a 20% statistically significant decreased risk compared with those who had a level of 9.0-9.4 mg/dL.

“We suggest that providers caring for patients with CKD should anticipate a high likelihood that their patients may develop pruritus and, thus, incorporate frequent screening for pruritus and associated risk factors into routine clinical care,” Dr Wulczyn and colleagues concluded.

Depressive symptoms and weight, they wrote, “warrant further investigation as potentially modifiable risk factors that could be targets for a multifaceted approach to the treatment of pruritus in CKD.”


Wulczyn K, Rhee E, Myint L, Kalim S, Shafi T. Incidence and risk factors for pruritus in patients with nondialysis CKD. Clin J Am Soc Nephrol. Published online December 14, 2022. doi:10.2215/CJN.09480822