There are no agreed-upon guidelines for the diagnosis and management of uremic pruritus, which has resulted in underdiagnosis of the condition and generally subpar patient care. According to reports, the prevalence varies greatly between nations as well as between centres within one nation. Pathogenesis is linked to a number of risk factors, many of which are not fully understood. The majority of the time, pruritus is persistent and recurrent, bilaterally symmetrical, affects the trunk, back, and limbs, has no primary skin lesions, and is worse at night. The patient’s QOL is significantly impacted by CKD-aP, which has a negative impact on their sleep and social functioning. There is no one treatment that works for all cases of uremic pruritus because there are numerous contributing factors, and these factors differ greatly between patients [1, 2, 7, 8].

In this study of 120 patients analysed, we found the prevalence of uremic pruritus to be 55.8% (n = 67) in our maintenance hemodialysis patients which is similar to the Indian study by Kaur et al. [10] in 2019 wherein a total of 164 patients were analysed and they found to have a prevalence of 53.7% and is also similar to a Chinese study by Zhao et al. [11] study, which found 60 cases of uremic pruritus among 148 eligible patients (40.54%). According to some older series, the prevalence of uremic pruritus among patients receiving hemodialysis ranges from 22–84% to as high as 90% [12,13,14,15,16,17,18].

The average age in this study was 56.5 ± 11.3 years, 55 (82%) were males, 16 (23.8%) had diabetic kidney disease, 64 were non-smokers and 4 patients were seropositive. This was similar to a study by Kaur et al. [10] wherein the average age of the cohort was 52 ± 17 years, and it included 95 (57.9%) males and 69 (42.1%) females, diabetic kidney disease (n = 70, 42.7%) was the commonest cause for end-stage kidney disease, 8 were active smokers and 13 were seropositive. Our study is also similar to the Chinese trial by Zhao et al. [11] wherein among 148 eligible subjects 89 were males (60.1%) and 59 females (39.9%) with diabetes seen in 35 (23.6%) patients.

In our study among 67 patients, 49/67 (40.8%) had a mild itch, 13/67 (19.4%) had a moderate itch and 5/67 (4.1%) had a severe itch. This was slightly deviant from other studies where a majority of the studies have shown moderate itch to be the commonest such as Singh et al. [19] wherein 23.3% had “mild itch”, 53.4% had “moderate itch” and 23.3% of them had “severe itch”; Zhao et al. [11] showed 22 (14.8%) cases of “mild itch”, 30 (20.2%) cases of “moderate itch” (20.27%), and 8 (5.4%) cases of “severe itch” (5.41%); Kaur et al. [10] displayed mild itch in 28 patients (31.8%), moderate itch in 40 patients (45.5%), and severe itch in 20 patients (22.7%).

In our study, there was no significant association between clinical characteristics and uremic pruritus which is similar to several other studies [20,21,22] wherein no statistically prominent association was noted with factors such as age, sex, etiology of uremia, smoking, and seropositive status. In this study, there was also no significant association observed between dialysis-related factors such as vintage, duration, frequency, and adequacy of dialysis as well as laboratory factors traditionally involved such as anaemia, hypoalbuminemia, hypocalcemia, hyperphosphatemia, and high levels of intact PTH which is also observed in several other studies [20,21,22] wherein no positive association was seen with low hemoglobin, low serum albumin, low calcium, high phosphorus, and high levels of PTH in those with pruritus among patients of end-stage kidney disease.

In our study with increasing severity of pruritus, the SKINDEX-10 showed worsening symptom-related, emotional, and functional quality of life parameters. Similarly, Itch-MOS revealed that they had poorer sleep quality and quantity, as well as worsening renal itch. Numerous other studies have proven a connection between pruritus and poorer quality of life, insomnia, depression, an independent predictor of mortality, and other detrimental patient outcomes. However, very few studies have systematically correlated the severity of pruritus with various parameters, as ours has. Additionally, according to Lopes et al. [23], patients with severe pruritus had a 25% lower quality of life-related to the burden of kidney disease, primarily as a result of sleep disturbances, depressive symptoms, and dry skin. Mathur et al. [24] found a statistically significant link between the severity of pruritus and “HR-QOL”, particularly in terms of mood, social connections, and sleep. They also found that a 20% change in itching intensity over time was associated with clinically significant changes in HR-QOL. The largest study to look into HR-QOL was carried out by DOPPS [5], utilizing general scales ["36-item short-form health survey (SF-36) and 12-item short-form health survey (SF-12),"] and proved that those with more itching had poorer HR-QOL. Similar findings were also made by Kosmadakis et al. [25] and Tessari et al. [26]