Uremic pruritus and its relationship with geriatric syndromes in older hemodialysis patients: analysis using the 5-D itch scale

BACKGROUND: Uremic pruritus (UP) is a common and distressing symptom in hemodialysis patients and may contribute to geriatric syndromes such as impaired sleep, depression, cognitive decline, and functional limitation. Evidence focusing on comprehensive geriatric assessment in older hemodialysis populations remains limited. OBJECTIVES: To evaluate the association between UP severity (5-D Itch Scale) and geriatric syndromes (functional status, cognitive function, depressive symptoms, nutritional status, and sleep quality) in older hemodialysis patients. METHODS: This cross-sectional study included patients aged ≥65 years who had undergone hemodialysis for at least 6 months. UP was assessed using the 5-D Itch Scale. Comprehensive geriatric assessment comprised Activity of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Geriatric Depression Scale-15 (GDS-15), Mini Nutritional Assessment-Short Form (MNA-SF), and Pittsburgh Sleep Quality Index (PSQI). Group comparisons were performed using nonparametric tests, and associations were examined using Spearman correlation. RESULTS: A total of 118 older hemodialysis patients were included; 70.4% (n = 83) reported UP. Vitamin D levels were lower in patients with UP. Compared with patients without UP, those with UP had lower MMSE scores, and higher GDS and PSQI scores. 5-D score correlated positively with age, depressive symptoms, sleep disturbance, and ADL dependency; and negatively with dialysis duration and cognitive function. CONCLUSIONS: In older hemodialysis patients, UP is common and is associated with worse sleep quality, more depressive symptoms, lower cognitive performance, and greater functional limitation. Integrating UP screening into routine geriatric assessment may help identify vulnerable patients and guide multidisciplinary symptom management strategies.