Review: the effect of polymethylmethacrylate dialysis membranes on uraemic pruritus.

Despite improvements in dialysis technology, including the development of novel biocompatible membranes and ultrapure dialysate, uraemia-associated pruritus (UP) remains a common and significant public health issue [1]. Not only does this distressing symptom profoundly impact on the quality of life and sleep, but recent evidence shows that pruritus is also associated with poor patient outcome. In the international Dialysis Outcomes and Practice Patterns Study (DOPPS) [2], which evaluated more than 18 000 patients on haemodialysis (HD) therapy, pruritus was associated with a 17% greater mortality risk, an effect that was no longer significant after adjustment for measures of sleep quality. Nonetheless, nephrologists and other health care professionals often fail to recognize and adequately address the pruritus associated with chronic uraemia. The prevalence of chronic kidney disease (CKD)-associated pruritus varies substantially, ranging from 22 to 90% [2– 6]. In the largest and most recent epidemiological study to date, the prevalence of CKD-associated pruritus was 42% [2]. Although this is a lower prevalence than initially reported, pruritus in patients with CKD remains frequent and continues to be a significant public health concern.