Strong Associations Between Inflammation, Pruritus and Mental Health in Dialysis Patients
Severin Schricker, Thorsten Heider, Moritz Schanz, Jürgen Dippon, Mark Dominik Alscher, Heinz Weiss, Thomas Mettang, Martin Kimmel
Pruritus, impaired mental health and inflammation contribute to morbidity in end-stage renal disease. There are no studies on all 3 conditions. We therefore obtained inflammatory parameter data (C-reactive protein and interleukin-6), pruritus data and psychological test data (36-Item Short-Form Health Survey, “Allgemeine Depressionsskala” and Toronto Alexithymia Scale-20) for 19 dialysis patients with pruritus, 20 dialysis patients without pruritus and 15 healthy controls. Non-parametric hierarchical clustering revealed 3 clusters of parameters: one mainly driven by pruritus scores (chronic kidney disease-associated pruritus cluster), one by mental health scores (mental health cluster) and one by inflammatory parameters (inflammatory cluster). Factor analysis showed strong associations (mental health cluster/chronic kidney disease-associated pruritus cluster, r=–0.49; mental health cluster/inflammatory cluster, r=–0.52; inflammatory cluster/chronic kidney disease-associated pruritus cluster, r=0.48). For the first time, complete correlations between inflammation, mental health and pruritus in dialysis patients have been established. As all 3 conditions are associated with mortality, knowledge about their interdependence helps to understand end-stage renal disease pathophysiology.
Itch, impaired mental health and inflammation contribute to morbidity in dialysis patients. We therefore analysed laboratory results, intensity of itch and psychological tests in dialysis patients with pruritus, without and healthy people. The data was analysed by different statistical tests. This revealed 3 independent groups. One was mainly driven by itch, one by mental health and another by inflammatory parameters. Additionally, all 3 showed strong associations. This means inflammation, mental health and itch are somehow interconnected in dialysis patients. Since all 3 comorbidities are associated with the risk of death, knowledge about the interdependence of these factors is important.