OBJECTIVE:This study investigated the association between self-reported shift work and change in kidney function in women and men in a multiethnic cohort. METHOD:Data from the prospective Life in Urban Setting (HELIUS) cohort (3812 women, 3488 men), including adults from 6 ethnic backgrounds based in the Netherlands, were used to assess associations between self-reported shift work and change in estimated glomerular filtration rate (eGFR) and albumin to creatinine ratio (ACR) using sex-stratified linear regressions and mediation analyses. RESULTS:Shift work was associated with a significant decline in eGFR but not ACR among men versus non-shift workers. No significant associations were found for change in eGFR or ACR in women overall. No evidence was found for a mediating role of traditional- and lifestyle-related chronic kidney disease risk factors. CONCLUSION:Shift work may be detrimental to kidney health. Employers and policymakers should consider addressing the potential kidney health risks of shift work, particularly in men.

Rationale & Objective:Data on sex differences in kidney function within multiethnic populations are scarce despite the large differences in chronic kidney disease (CKD) in women and men. We investigated the 6-year changes in the estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) in women and men, both overall and across ethnic groups, and determined whether sex differences in associations with outcomes are mediated by known CKD risk factors. Study Design:General population based longitudinal study. Setting & Participants:We used prospective data of 5,713 women and 4,407 men from 6 ethnic backgrounds from the Healthy Life in an Urban Setting (HELIUS) study (Amsterdam, the Netherlands). Exposures:Municipality registered sex. Outcomes:Change in eGFR (mL/min/1.73 m2) and ACR (mg/mmol) between baseline (2011-2015) and follow-up (2019-2021) data collection. CKD incidence and progression were analyzed as secondary outcomes. Analytical Approach:Linear regression analyses adjusted for baseline kidney function estimates, follow-up duration, age, education, and ethnicity in the total population and stratified by ethnicity. Mediation by hypertension, diabetes, cardiovascular disease, obesity, physical activity, alcohol consumption, and smoking was tested. Results:Although no significant sex differences were found in the overall population, Dutch and African Surinamese women had a greater decrease in eGFR (β:1.2 (0.5-1.8)) than men, whereas South-Asian Surinamese and Moroccan men had a greater decrease in eGFR (β:-1.0 (-2.0 to 0.0)) than women. ACR was higher in men, although this difference did not reach statistical significance (β:0.6 (0.3-1.1), P = 0.09). Sex differences in CKD incidence across certain ethnic groups aligned with the observed eGFR differences, whereas CKD progression was higher in men overall. Little evidence of mediation by CKD risk factors of the sex differences was observed. Limitations:Single eGFR and ACR measurements, self-reported mediator variables, and limited generalizability. Conclusions:Disparate sex differences in the changes in eGFR, CKD incidence, and progression were observed, specifically in some ethnic groups. These differences were not mediated by differences in traditional risk factors and health-related behaviors.

Objective: To investigate whether the currently recommended screening criteria in Kidney Disease: Improving Global Outcomes 2024 guidelines (hypertension, diabetes mellitus, and cardiovascular disease) equally detect women and men across ethnic groups and whether consideration of optional criteria (education level, occupation, obesity, and genetic risk factors) listed in the guideline improves performance. Patients and Methods: We included 12,384 women and 9046 men of Dutch, South Asian and African Surinamese, Ghanaian, Turkish, and Moroccan origin from the baseline HELIUS Study (January 1, 2011, through December 31, 2015, Amsterdam, the Netherlands). Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2 or albumin-to-creatinine ratio of >3 mg/mmol. Poisson regression analyses estimated associations between CKD and optional criteria on top of current screening criteria. Model comparisons were made with likelihood ratio tests and Akaike information criterion estimations in women and men. Area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values were calculated by sex and ethnicity. Results: Chronic kidney disease prevalence ranged from 2.9% to 8.8% in women and 3.2% to 8.6% in men. Low educational level (women only) and obesity significantly improved the models with current criteria with CKD. High-risk occupations and polygenic risk score did not improve the model. However, these criteria did not improve predictive measures across ethnic groups. Overall, the AUCs for the current screening criteria were acceptable in men (AUC, 0.75; 95% CI, 0.73-0.77) and poor in women (AUC, 0.65; 95% CI, 0.63-0.67), and showed minimal change after adding the optional criteria. Conclusion: Current screening criteria may not be equally detecting women and men across ethnic groups with CKD. Optional criteria had limited added value.

In chronic kidney disease (CKD), prevalence differences between sexes have been reported. While biological factors have been investigated, research on sociocultural factors is scarce. We explore the extent gender-related characteristics associate with, and contribute to, CKD prevalence in women and men in a multi-ethnic population. Cross-sectional analyses were performed on data of 12,221 women and 8,930 men aged 18-70 years across six ethnic groups from the HELIUS Study. Using age-, education-, and ethnicity adjusted Poisson regression, we determined associations between time spent on housework; primary earner status; employment status; and occupational segregation, and CKD. Population attributable fractions estimated the contribution to CKD and the extent traditional CKD risk factors explained these contributions. In women, associations with CKD were found for doing little housework, part-time work, and unemployment. In men, primary-earnership and unemployment were associated. Associations aligned across ethnic groups. Estimated contributions ranged from 1.8% for women doing little housework to 26.5% for part-time employment and 12.1% for unemployment to 37.5% for primary-earnership in men, and were hardly explained by traditional risk factors. In our study, gender-related characteristics are associated with CKD in women and men across ethnic groups. Contributions to population prevalence may hardly be explained by CKD risk factors. The prevalence of chronic kidney disease (CKD) differs between women and men. We explored to what extent the risk may be associated with sociocultural expectations for women and men. We analysed data of 12,221 women and 8,930 men from six different ethnic groups. CKD was more common in all women who did little housework, worked part-time or were unemployed, and in men whose financial contribution was equal to their partners or who were unemployed. The higher risk of CKD was not explained by a higher occurrence of known risk factors. In future, specific policies or targeted interventions may be developed to reduce the risk of CKD overall and in certain population subgroups.

Hemodialysis is an intensive treatment with a substantial time burden for patients. Generally, a standard hemodialysis schedule consists of three treatments per week, each lasting 4 hours. However, it can be debated whether this schedule is appropriate for all patients. Incremental hemodialysis refers to a treatment approach where hemodialysis is initiated with a less intensive schedule ( i.e ., fewer sessions per week) and gradually increased as residual kidney function declines. The effects of incremental hemodialysis on key outcomes—health-related quality of life, vascular access-related complications, and fluid overload—were discussed in this review. Although incremental hemodialysis is hypothesized to improve health-related quality of life, most studies found no significant difference. Similarly, most studies did not report significant differences in vascular access-related complications. Concerns have been raised regarding fluid overload due to extended intervals between sessions and underdialysis, especially when the transition to a thrice-weekly schedule is delayed. However, most studies found no difference in fluid overload related outcomes. Incremental hemodialysis is a promising, personalized treatment that could reduce the socioeconomic burden of dialysis. Given the methodologic limitations of available studies, ongoing trials will contribute to a clearer understanding of the role of incremental hemodialysis with varying residual kidney function at initiation.

OBJECTIVES:This study aimed to assess construct validity against commonly used patient-reported outcome measures (PROMs), test-retest reliability and responsiveness of seven Dutch-Flemish Patient-Reported Outcomes Measurement Information System (PROMIS) computerised adaptive testing (CATs) in Dutch adults with type 2 diabetes (T2D), and assess their acceptability in healthcare providers and people with T2D. DESIGN:A cross-sectional observational study in people with T2D and qualitative study involving both people with T2D and healthcare professionals. SETTING:Participants with T2D were recruited from the ongoing Hoorn Diabetes Care System cohort in the West-Friesland area of the Netherlands. Additionally, people with T2D and advanced chronic kidney disease were recruited at the outpatient clinics of Amsterdam University Medical Centre and 'Niercentrum aan de Amstel', both in the Amsterdam area of the Netherlands. The healthcare professionals involved in the qualitative part were recruited at the Amsterdam University Medical Centre. PARTICIPANTS:314 people with T2D (age 64.0±10.8 years, 63.7% men). PRIMARY AND SECONDARY OUTCOME MEASURES:Participants completed seven PROMIS CATs (assessing (1) Physical Function, (2) Pain Interference, (3) Fatigue, (4) Sleep Disturbance, (5) Anxiety, (6) Depression and (7) Ability to Participate in Social Roles and Activities), and PROMs measuring similar constructs. After 2 weeks and 6 months, participants completed the CATs measures again, together with seven Global Rating Scales (GRS) on perceived change in each domain. Construct validity was assessed using Pearson's correlations. Test-retest reliability was assessed by the intraclass correlation coefficient (ICC). Measurement error was assessed by the standard error of measurement (SEM) and minimal detectable change (MDC). Responsiveness was assessed by correlations between change scores on the PROMIS CAT and GRS. Acceptability was assessed through focus groups and interviews in healthcare providers and people with T2D. RESULTS:Except for Fatigue, all PROMIS CAT domains demonstrated sufficient construct validity, since ≥75% of the results was in accordance with a priori hypotheses. All seven PROMIS CATs showed sufficient test-retest reliability (ICCs 0.73-0.91). SEM and MDC ranged from 2.1 to 2.7 and from 5.7 to 7.4, respectively. Responsiveness was rated as insufficient in this study design as there was almost no change in participants' own rating of their health compared with 6 months ago according to a global rating of change.During the focus groups and interviews, healthcare providers and people with T2D agreed that CATs could serve as a conversation starter in routine care, but should never replace personal consultations with a doctor. If implemented, participants would be willing to spend 15 min to complete the PROMIS CATs. CONCLUSIONS:The PROMIS CATs showed sufficient construct validity and test-retest reliability in most domains in people with T2D. Responsiveness needs to be evaluated in a population with poorer diabetes control or in a study design with longer follow-up. The CATs are well accepted to be used in care to identify relevant topics, but should not replace personal contact with the doctor.

In kidney transplantation, survival rates are still partly impaired due to the deleterious effects of donor specific HLA antibodies (DSA). However, not all luminex‐defined DSA appear to be clinically relevant. Further analysis of DSA recognizing polymorphic amino acid configurations, called eplets or functional epitopes, might improve the discrimination between clinically relevant vs. irrelevant HLA antibodies. To evaluate which donor epitope‐specific HLA antibodies (DESAs) are clinically important in kidney graft survival, relevant and irrelevant DESAs were discerned in a Dutch cohort of 4690 patients using Kaplan–Meier analysis and tested in a cox proportional hazard (CPH) model including nonimmunological variables. Pre‐transplant DESAs were detected in 439 patients (9.4%). The presence of certain clinically relevant DESAs was significantly associated with increased risk on graft loss in deceased donor transplantations ( p < 0.0001). The antibodies recognized six epitopes of HLA Class I, 3 of HLA‐DR, and 1 of HLA‐DQ, and most antibodies were directed to HLA‐B (47%). Fifty‐three patients (69.7%) had DESA against one donor epitope (range 1–5). Long‐term graft survival rate in patients with clinically relevant DESA was 32%, rendering DESA a superior parameter to classical DSA (60%). In the CPH model, the hazard ratio (95% CI) of clinically relevant DESAs was 2.45 (1.84–3.25) in deceased donation, and 2.22 (1.25–3.95) in living donation. In conclusion, the developed model shows the deleterious effect of clinically relevant DESAs on graft outcome which outperformed traditional DSA‐based risk analysis on antigen level.

10.1093/ndt/gfae038 Video Watch the video of this contribution at https://academic.oup.com/ndt/pages/author_videos gfae038Media1 6348069834112

In kidney transplantation, donor HLA antibodies are a risk factor for graft loss. Accessibility of donor eplets for HLA antibodies is predicted by the ElliPro score. The clinical usefulness of those scores in relation to transplant outcome is unknown. In a large Dutch kidney transplant cohort, Ellipro scores of pretransplant donor antibodies that can be assigned to known eplets (donor epitope specific HLA antibodies [DESAs]) were compared between early graft failure and long surviving deceased donor transplants. We did not observe a significant Ellipro score difference between the two cohorts, nor significant differences in graft survival between transplants with DESAs having high versus low total Ellipro scores. We conclude that Ellipro scores cannot be used to identify DESAs associated with early versus late kidney graft loss in deceased donor transplants.

Key PointsIncident dialysis patients show a high prevalence of pruritus during the first year of dialysis, with pruritus being either persistent or fluctuating.Medical treatment for pruritus does not improve quality of life within the 25% of patients with pruritus receiving it.High prevalence, negative effect, and low treatment rate of pruritus urges for more awareness, for instance, by the means of patient reported outcomes.BackgroundPruritus is common in dialysis patients and associated with impaired health-related quality of life (HRQoL) and sleep disturbances. Its pathophysiology remains unclear, resulting in limited treatment options and lack of treatment guidelines. The exact trajectory of pruritus after dialysis initiation, nor the state of current medical treatment, has been studied.MethodsIncident dialysis patients (N=1438) included in the Dutch nocturnal and home dialysis study to improve clinical outcomes were studied. Outcome parameters were prevalence of pruritus, severity of pruritus, and the use of antipruritic medication, repeatedly measured during the first year of dialysis. Associations between treatment, pruritus, and quality of life were longitudinally studied using linear mixed models.ResultsThe prevalence of pruritus ranged from 50.5% to 56.6% during the first year of dialysis. Throughout the year, approximately 35% experienced persistent pruritus and 40% fluctuating pruritus. During follow-up, 21.5%-26.5% received medical treatment for pruritus. Emollients were associated with more severe pruritus (adjusted beta=0.31; 95% confidence interval [CI], 0.15 to 0.48); the remaining treatments did not show any association. Pruritus was significantly associated with lower physical and mental HRQoL (adjusted beta=-2.04; 95% CI, -2.78 to -1.30 and beta=-1.73; 95% CI, -2.51 to -0.94, respectively), irrespective of treatment.ConclusionsDuring the first year of dialysis, pruritus is highly prevalent, predominantly fluctuating, and associated with impaired HRQoL. The minority of patients received medical treatment; in our study, current treatment was not associated with an improvement of pruritus. These results highlight the need for more awareness among clinicians and for the development of effective treatment options.

Background: Technique survival is a core outcome for peritoneal dialysis (PD), according to Standardized Outcomes in Nephrology-Peritoneal Dialysis. This study aimed to identify modifiable causes and risk factors of technique failure in a large Dutch cohort using standardised definitions. Methods: Patients who participated in the retrospective Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes cohort study and started PD between 2012 and 2016 were included and followed until 1 January 2017. The primary outcome was technique failure, defined as transfer to in-centre haemodialysis for ≥ 30 days or death. Death-censored technique failure was analysed as secondary outcome. Cox regression models and competing risk models were used to assess the association between potential risk factors and technique failure. Results: A total of 695 patients were included, of whom 318 experienced technique failure during follow-up. Technique failure rate in the first year was 29%, while the death-censored technique failure rate was 23%. Infections were the most common modifiable cause for technique failure, accounting for 20% of all causes during the entire follow-up. Leakage and catheter problems were important causes within the first 6 months of PD treatment (both accounting for 15%). APD use was associated with a lower risk of technique failure (hazard ratio 0.66, 95% confidence interval 0.53–0.83). Conclusion: Infections, leakage and catheter problems were important modifiable causes for technique failure. As the first-year death-censored technique failure rate remains high, future studies should focus on infection prevention and catheter access to improve technique survival.

ABSTRACT Background In chronic haemodialysis (HD) patients, the relationship between long-term peridialytic blood pressure (BP) changes and mortality has not been investigated. Methods To evaluate whether long-term changes in peridialytic BP are related to mortality and whether treatment with HD or haemodiafiltration (HDF) differs in this respect, the combined individual participant data of three randomized controlled trials comparing HD with HDF were used. Time-varying Cox regression and joint models were applied. Results During a median follow-up of 2.94 years, 609 of 2011 patients died. As for pre-dialytic systolic BP (pre-SBP), a severe decline (≥21 mmHg) in the preceding 6 months was independently related to increased mortality [hazard ratio (HR) 1.61, P = .01] when compared with a moderate increase. Likewise, a severe decline in post-dialytic diastolic BP (DBP) was associated with increased mortality (adjusted HR 1.96, P < .0005). In contrast, joint models showed that every 5-mmHg increase in pre-SBP and post-DBP during total follow-up was related to reduced mortality (adjusted HR 0.97, P = .01 and 0.94, P = .03, respectively). No interaction was observed between BP changes and treatment modality. Conclusion Severe declines in pre-SBP and post-DBP in the preceding 6 months were independently related to mortality. Therefore peridialytic BP values should be interpreted in the context of their changes and not solely as an absolute value.

Abstract Background The Patient-Reported Outcomes Measurement Information System (PROMIS®) has the potential to harmonize the measurement of health-related quality of life (HRQL) across medical conditions. We evaluated responsiveness and minimal important change (MIC) of seven Dutch-Flemish PROMIS computerized adaptive tests (CAT) in Dutch patients with advanced chronic kidney disease (CKD). Methods CKD patients (eGFR < 30 ml/min.1.73m2) completed at baseline and after 6 months seven PROMIS CATs (assessing physical function, pain interference, fatigue, sleep disturbance, anxiety, depression, and ability to participate in social roles and activities), Short Form Health Survey 12 (SF-12), PROMIS Pain Intensity single item, Dialysis Symptom Index (DSI), and Global Rating Scales (GRS) of change. Responsiveness was assessed by testing predefined hypotheses about expected correlations among measures, area under the ROC Curve, and effect sizes. MIC was determined with predictive modelling. Results 207 patients were included; 186 (90%) completed the follow-up. Most results were in accordance with expectations (70–91% of hypotheses confirmed), with some exceptions for PROMIS Anxiety and Ability to Participate (60% and 42% of hypotheses confirmed, respectively). For PROMIS Anxiety and Depression correlations with the GRS were too low (0.04 and 0.20, respectively) to calculate a MIC. MIC values, representing minimal important deterioration, ranged from 0.4 to 2.5 T-score points for the other domains. Conclusion We found sufficient responsiveness of PROMIS CATs Physical Function, Fatigue, Sleep Disturbance, and Depression. The results for PROMIS CATs Pain Interference were almost sufficient, but some results for Anxiety and Ability to Participate in Social Roles and Activities were not as expected. Reported MIC values should be interpreted with caution because most patients did not change.

End-stage kidney disease patients treated with conventional hemodialysis (CHD) are known to have impaired physical performance and protein-energy wasting (PEW). Nocturnal hemodialysis (NHD) was shown to improve clinical outcomes, but the evidence is limited on physical performance and PEW. We investigate whether NHD improves physical performance and PEW. This prospective, multicenter, non-randomized cohort study compared patients who changed from CHD (2–4 times/week 3–5 h) to NHD (2–3 times/week 7–8 h), with patients who continued CHD. The primary outcome was physical performance at 3, 6 and 12 months, assessed with the short physical performance battery (SPPB). Secondary outcomes were a 6-minute walk test (6MWT), physical activity monitor, handgrip muscle strength, KDQOL-SF physical component score (PCS) and LAPAQ physical activity questionnaire. PEW was assessed with a dietary record, dual-energy X-ray absorptiometry, bioelectrical impedance spectroscopy and subjective global assessment (SGA). Linear mixed models were used to analyze the differences between groups. This study included 33 patients on CHD and 32 who converted to NHD (mean age 55 ± 15.3). No significant difference was found in the SPPB after 1-year of NHD compared to CHD (+0.24, [95% confidence interval −0.51 to 0.99], p = 0.53). Scores of 6MWT, PCS and SGA improved (+54.3 [95%CI 7.78 to 100.8], p = 0.02; +5.61 [−0.51 to 10.7], p = 0.03; +0.71 [0.36 to 1.05], p < 0.001; resp.) in NHD patients, no changes were found in other parameters. We conclude that NHD patients did not experience an improved SPPB score compared to CHD patients; they did obtain an improved walking distance and self-reported PCS as well as SGA after 1-year of NHD, which might be related to the younger age of these patients.

ABSTRACT Background The Patient-Reported Outcomes Measurement Information System (PROMIS®) has been recommended for computerized adaptive testing (CAT) of health-related quality of life. This study compared the content, validity, and reliability of seven PROMIS CATs to the 12-item Short-Form Health Survey (SF-12) in patients with advanced chronic kidney disease. Methods Adult patients with chronic kidney disease and an estimated glomerular filtration rate under 30 mL/min/1.73 m2 who were not receiving dialysis treatment completed seven PROMIS CATs (assessing physical function, pain interference, fatigue, sleep disturbance, anxiety, depression, and the ability to participate in social roles and activities), the SF-12, and the PROMIS Pain Intensity single item and Dialysis Symptom Index at inclusion and 2 weeks. A content comparison was performed between PROMIS CATs and the SF-12. Construct validity of PROMIS CATs was assessed using Pearson's correlations. We assessed the test-retest reliability of all patient-reported outcome measures by calculating the intraclass correlation coefficient and minimal detectable change. Results In total, 207 patients participated in the study. A median of 45 items (10 minutes) were completed for PROMIS CATs. All PROMIS CATs showed evidence of sufficient construct validity. PROMIS CATs, most SF-12 domains and summary scores, and Dialysis Symptom Index showed sufficient test-retest reliability (intraclass correlation coefficient ≥ 0.70). PROMIS CATs had a lower minimal detectable change compared with the SF-12 (range, 5.7–7.4 compared with 11.3–21.7 across domains, respectively). Conclusion PROMIS CATs showed sufficient construct validity and test-retest reliability in patients with advanced chronic kidney disease. PROMIS CATs required more items but showed better reliability than the SF-12. Future research is needed to investigate the feasibility of PROMIS CATs for routine nephrology care.

Abstract BACKGROUND AND AIMS Accumulating evidence shows that online post-dilution haemodiafiltration (HDF), especially when a high convection volume is achieved, is associated with a lower mortality risk than haemodialysis (HD) [1]. The mechanism behind this effect, however, is unclear. In this respect, a superior intradialytic organ perfusion and hence, less intestinal tissue damage, permitting the transfer of bacteria from the gut to the blood, might play an important role. Therefore, we assessed whether differences exist in the intradialytic translocation of intact bacteria between four dialysis modalities. METHOD A randomized cross-over trial was performed (NCT03249532, ClinicalTrials.gov) in 11 prevalent dialysis patients, who were exposed to four dialysis strategies: HD with standard dialysate temperature (Td) 36.5°C and cool (Td 35.5°C) dialysate, and HDF with a high (≥23 L/1.73 m2/session) and low (15 L/1.73 m2/session) convection volume. Microbial DNA (mDNA), soluble CD14, high-sensitivity CRP and IL-6 receptor were measured during each modality, as secondary endpoints of this study. Quantitative assessment of mDNA was performed by 16S-23S interspace profiling after DNA isolation [2, 3]. In the current analysis, the quantitative difference in circulating mDNA between modalities was investigated. In addition, differences in the acute phase reaction (APR), as measured by soluble CD14, high-sensitivity CRP and IL-6 receptor and potential relations between mDNA and the APR were analysed. RESULTS DNA of intact bacteria could not be demonstrated in blood samples of the patients in any dialysis strategy. Yet, in all modalities a similar increase in IL-6 receptor, high-sensitivity CRP and soluble CD14 was observed (pre- versus post-dialysis: P-values <.05) (Figures 1A-B). CONCLUSION i) The appearance of DNA from intact bacteria in the blood of dialysis patients could not be demonstrated, despite the use of a sensitive state-of-the-art technique, which is free from contamination by human DNA; ii) during all modalities a comparable and significant APR was observed; iii) hence, the intradialytic APR does not seem to result from translocated intact bacteria.

Aim Over the past years the proportion of home dialysis patients has decreased in the Netherlands. In addition, the home dialysis use varies significantly among centres. It is unclear whether this is the result of differences in comorbidity, or other factors. Our aim was to investigate the association between comorbidity and dialysis modality choice. Methods The multi-centre DOMESTICO cohort study collected comorbidity data of patients who started dialysis in 35 Dutch centres from 2012 to 2016. Comorbidity was assessed by the Charlson comorbidity index. Home dialysis was defined as any peritoneal dialysis or home haemodialysis treatment during follow-up. Multivariable logistic regression analysis was used to assess the association between comorbidity and dialysis modality, with a mixed model approach to adjust for clustering of patients within dialysis centres. Results A total of 1358 patients were included, of whom 628 were treated with home dialysis. In crude mixed model analyses, the probability of receiving home dialysis was lower when comorbidity score was higher: having a high comorbidity score resulted in an odds ratio of 0.74 (95% CI 0.54-1.00) when compared with patients without comorbidities. After adjustments for age, sex, ethnic background, body mass index and dialysis vintage, there was no association between comorbidity and home dialysis. Conclusion Comorbidity was not significantly associated with home dialysis choice, after adjustment for several confounding factors including age and body mass index. Future studies should aim at unravelling the centre-specific characteristics that probably play a role in dialysis modality choice.

ABSTRACT Background Itching (pruritus) is common in dialysis patients, but little is known about its impact on health-related quality of life (HRQOL), sleep problems and psychological symptoms. This study investigates the impact of itching in dialysis patients by looking into the persistence of itching, the effect of itching on the course of HRQOL and the combined effect of itching with sleep problems and with psychological symptoms on HRQOL. Methods Data were obtained from the RENINE/PROMs registry and included 2978 dialysis patients who completed patient-reported outcome measures between 2018 and 2020. Itching, sleep problems and psychological symptoms were assessed with the Dialysis Symptom Index (DSI) and HRQOL with the 12-item Short Form Health Survey. Effects of itching on HRQOL and interactions with sleep problems and psychological symptoms were investigated cross-sectionally and longitudinally using linear regression and linear mixed models. Results Half of the patients experienced itching and in 70% of them, itching was persistent. Itching was associated with a lower physical and mental HRQOL {−3.35 [95% confidence interval (CI) −4.12 to −2.59) and −3.79 [95% CI −4.56 to −3.03]}. HRQOL remained stable during 2 years and trajectories did not differ between patients with or without itching. Sleep problems (70% versus 52%) and psychological symptoms (36% versus 19%) were more common in patients with itching. These symptoms had an additional negative effect on HRQOL but did not interact with itching. Conclusions The persistence of itching, its impact on HRQOL over time and the additional effect on HRQOL of sleep problems and psychological symptoms emphasize the need for recognition and effective treatment of itching to reduce symptom burden and improve HRQOL.