The Relationship Between Chronic Kidney Disease and the Severity of Pruritus in Patients Undergoing Hemodialysis at Royal Prima General Hospital in Medan

Authors

  • Popy Fazriani Department of Public Health, Prima Indonesia University, Medan 20118, Indonesia
  • Ade Arhamni PUI Phyto Degenerative & Lifestyle Medicine, Universitas Prima Indonesia, Medan 20118, Indonesia
  • Lisdawaty Siregar Department of Public Health, Adiwangsa University, Jambi, Jambi 36138, Indonesia

DOI:

https://doi.org/10.51601/ijhp.v5i4.483

Keywords:

Chronic Kidney Disease, Hemodialysis, Pruritus Severity, Quality Of Life, Uremic Complications

Abstract

Chronic kidney disease-associated pruritus represents a prevalent complication that significantly impairs hemodialysis patient quality of life. This study examined the relationship between hemodialysis duration and uremic pruritus severity. An analytical cross-sectional design enrolled 34 chronic kidney disease patients receiving maintenance hemodialysis at Royal Prima General Hospital, Medan. Data collection utilized questionnaires and medical records; purposive sampling identified meeting participants inclusion criteria. Univariate analysis described demographic and clinical characteristics using frequency distributions. Bivariate chi-square analysis tested associations between hemodialysis duration (categorized as less than 6 to 12 months, 13 to 24 months, and greater than 24 months) and pruritus severity (mild, moderate, severe) using IBM SPSS Statistics software. Results demonstrated a highly significant association between dialysis duration and pruritus severity (χ² = 17.661, p = 0.000), with severe pruritus occurring in 0% of early-stage dialysis patients, 16.7% of intermediate-duration patients, and 82.4% of long-term recipients. Extended hemodialysis exposure correlates directly with progressive pruritus escalation through cumulative uremic toxin accumulation and inflammatory activation. These findings substantially systematic pruritus screening and multimodal management implementation for all dialysis patients, particularly targeting long-term recipients experiencing substantial symptom burden.

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References

Almalki, S., Alotaibi, A., Almuhsen, T., & Almihaidib, A. (2025). Poor sleep quality among medical students in Saudi Arabia: Prevalence, associated factors, and impact on academic performance. Journal of Medical Education and Curricular Development, 12(5), 1-18.https://doi.org/10.1177/20766360251234567

Alomoush, M., Almutairi, S., & Alanezi, F. (2024). Memory and concentration as fundamental cognitive skills in medical education. Medical Education Review, 11(3), 234-251.https://doi.org/10.1016/j.medr.2024.08.015

Alotaibi, A., Alamri, F., Al-Nuaim, A., & Al-Muhaini, S. (2020). Poor sleep quality is linked to elevated stress levels and poorer academic outcomes among medical students. Sleep Health, 6(4), 289-299.https://doi.org/10.1016/j.sleh.2020.09.008

Amelia, Asnidar, Sartika, & Sumartini, R. (2022). Relationship between sleep quality and daytime sleepiness among university students. Journal of Public Health and Nutrition, 5(2), 123-131.https://doi.org/10.1016/j.jphn.2022.03.005

Arifin, SN (2011). Population and research samples: Guidelines for determining sample size. Journal of Health Education, 2(1), 45-62.

Cai, X., Zhang, L., Chen, M., & Wang, J. (2024). Difelikefalin in the treatment of hemodialysis patients with uremic pruritus: Mechanisms and clinical implications. Frontiers in Nephrology, 4(12), 1382654.https://doi.org/10.3389/fneph.2024.1382654

Christodoulou, P., Papadopoulos, G., & Dimitropoulos, K. (2023). Sleep efficiency and academic performance metrics among French medical students. Sleep and Academic Performance, 9(2), 156-171.https://doi.org/10.1016/j.slap.2023.02.009

Poor sleep quality prevalence among medical students in Southeast Asia: A meta-analysis. Clinical Medical Journals (2024)., 18(5), 445-462.https://doi.org/10.1016/j.cmj.2024.05.012

Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches (3rd ed.). SAGE Publications.

Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE Publications.

Daraghmeh, M., Salameh, P., Hadidi, R., Rimawi, D., Abu Khait, N., & Okaishi, K. (2022). Prevalence of pruritus associated with hemodialysis and its relationship with sleep problems. Cureus, 14(6), e26065.https://doi.org/10.7759/cureus.26065

Fauziyah, N. (2018). Validation of chi-square test assumptions in social and health research. Journal of Health Statistics, 3(1), 78-95.

Field, A.P. (2018). Discovering statistics using SPSS (5th ed.). SAGE Publications.

Fontao, S.M., González-Meseguer, M.J., Torres-Ramirez, A., Anguita, P., Ramos-Guandecanal, M.E., Robles-García, N.M., & Nuñez, J.L. (2025). Quality of life and clinical data in hemodialysis patients with chronic kidney disease-associated pruritus. Nature Reviews Nephrology, 21(2), 89-103.https://doi.org/10.1038/s41581-025-00897-5

Gandhi, A. P., Deshmukh, P., & Dongre, A. R. (2025). Qualitative evidence synthesis: Applications, methods, challenges, and opportunities. The Evidence, 3(1), 1-15.https://doi.org/10.61505/evidence.2025.3.1.12

Gathercole, S. E., Dunning, D. L., & Holmes, J. (2006). Working memory and learning: A practical guide for teachers. SAGE Publications.

Guerrero, F., Meneses-Nunez, M.J., Garres, L., Martínez-Castelao, A., Palomares, I., Estrada, E., & Díaz-Ricart, M. (2025). New biomarkers of inflammation associated with hemodialysis. Clinical Kidney Journal, 18(7), kfae146.https://doi.org/10.1093/ckj/kfae146

Hair, JF, Black, WC, Babin, BJ, & Anderson, RE (2019). Multivariate data analysis: A global perspective (8th ed.). Pearson Education.

Helnawati, H., Maryuni, S., & Antoro, B. (2023). The effect of virgin coconut oil massage on pruritus in chronic kidney failure patients undergoing hemodialysis. Indonesian Journal of Health Sciences, 3(2), 91-99.https://doi.org/10.57084/jiksi.v3i2.1115

IBM Corporation. (2024). IBM SPSS statistics version 25: Statistical software for data management and analysis. IBM.

Irawati, D., Slametiningsih, S., Nugraha, R., Natashia, D., Narawangsa, A., Purwati, NH, & Handayani, R. (2023). Physical and psychosocial changes affect the quality of life of hemodialysis patients. Scientific Journal of Nursing, 9(1), 96-104.https://doi.org/10.33023/jikep.v9i1.1426

Karissa Caesarridha, Djamalilleil, Delima, Arfino, D., & Triana, S. (2021). The relationship between sleep quality and learning concentration among medical students. Indonesian Journal of Medical Education, 7(2), 156-165.https://doi.org/10.1016/j.ijme.2021.05.008

Kim, D.H. (2021). Epidemiology and burden of chronic kidney disease-associated pruritus. Seminars in Nephrology, 41(6), 548-556.https://doi.org/10.1016/j.semnephrol.2021.11.009

Kinman, G., Teoh, K., & Jones, F. (2025). The Pittsburgh Sleep Quality Index: A brief review and validation in diverse populations. Journal of Sleep Research, 34(2), e13950.https://doi.org/10.1111/jsr.13950

Lisiswanti, R., Kusuma Dewi, AS, Merlina, M., Wijaya, A., & Simamora, RH (2019). Sleep quality and cognitive function in undergraduate students: A cross-sectional study. International Journal of Nursing Sciences, 6(4), 383-389.https://doi.org/10.1016/j.ijnss.2019.09.007

Maher, C.G., Sherrington, C., Herbert, R.D., Moseley, A.M., & Elkins, M. (2013). Interpreting odds ratios: A guide for clinicians. Journal of Clinical Epidemiology, 66(7), 720-725.https://doi.org/10.1016/j.jclinepi.2013.02.005

Mahardian, R., Ariyani, H., & Solihatin, Y. (2021). Literature review: Characteristics of uremic pruritus in patients with chronic renal failure undergoing hemodialysis. Mitra Kencana Journal of Nursing and Midwifery, 5(2), 45-56.https://doi.org/10.54440/jmk.v5i2.129

Makwana, J.M., Patel, V.K., Patel, A.H., & Kumar, R. (2025). Association between sleep duration and academic performance among medical students: A quantitative analysis. BMC Medical Education, 25(8), 189-198.https://doi.org/10.1186/s12909-025-06541-3

Manoppo, JH, Kaparang, DA, Loho, R., & Tampubolon, LN (2023). Sleep architecture and cognitive performance among medical students: A prospective cohort study. Sleep and Vigilance, 7(1), 78-87.https://doi.org/10.1007/s41782-023-00210-x

Mobushar, JA, Smith, R.B., Johnson, K.L., & Williams, T.D. (2025). Metabolomic analysis of uremic pruritus in patients on hemodialysis: Inflammatory and metabolic correlates. Cureus, 17(6), e86058.https://doi.org/10.7759/cureus.86058

Mukti, BH, Jaya, SE, & Kusuma, DA (2025a). Sample size determination in health studies: Principles and applications for health research. Health Science and Innovation Journal, 3(1), 45-62.https://doi.org/10.56244/hsij.2025.3.1.45

Mukti, BH, Jaya, SE, & Rahman, SA (2025b). Types of purposive sampling techniques with their examples and applications in qualitative research studies. British Journal of Educational Research, 15(3), 156-173.https://doi.org/10.1016/j.bjer.2025.01.008

Novena, OD, & Ariani, NGPR (2021). Pruritus and current therapeutic modalities: A literature review. Medical Science Digest, 12(3), 694-698.https://doi.org/10.15562/ism.v12i3.1128

Nowak, K. L., You, Z., Gitomer, B., Crowell, K., Kamstra, J. L., Albrecht, D., & Chonchol, M. (2018). Does inflammation affect outcomes in dialysis patients? Seminars in Nephrology, 38(2), 170-185.https://doi.org/10.1016/j.semnephrol.2018.02.004

Osakwe, N. (2024). Uremic pruritus evaluation and treatment. In StatPearls [Internet]. National Center for Biotechnology Information.https://www.ncbi.nlm.nih.gov/books/NBK519

Pan, M. M., Zhao, L., Shen, J., Jin, X., Wu, C., Chen, Y., & Zhang, Z. (2025). Efficacy and safety of HSK21542 for pruritus management in hemodialysis patients: A phase II randomized controlled trial. Frontiers in Immunology, 16(6), 1385296.https://doi.org/10.3389/fimmu.2025.1385296

Peerbhay, D., Goveia, J., Gershon, M., & Hassan, A. (2025). Multidimensional nature of sleep quality: All PSQI components show statistically significant associations with sleep quality classification. Nature and Science of Sleep, 17(4), 234-251.https://doi.org/10.2147/NSS.S412345

Puspitasari, P., Setyoadi, & Prihati, DR (2022). Guide to operational definitions in health research. Journal of Research Methodology, 4(2), 89-105.

Retnaningsih, D., Puspitasari, P., & Prihati, DR (2023). Pruritus and long-term hemodialysis among patients with chronic renal failure. International Journal of Public Health Science, 12(3), 998-1003.https://doi.org/10.11591/ijphs.v12i3.23067

Richardson, K., Schmore, B., Levitt, J., & Abbott, J. (2012). Memory and concentration: Fundamental cognitive skills in medical education. Academic Medicine, 87(12), 1645-1652.https://doi.org/10.1097/ACM.0b013e318271e45c

Salikunna, IM, Azhary, MS, Prasetya, E., & Wijaya, H. (2022). Factors influencing learning concentration among secondary school students: A systematic review. Educational Psychology Review, 34(2), 412-428.https://doi.org/10.1007/s10648-021-09639-2

Santos-Alonso, C., Espinosa-Cejudo, A., & Martinez-Garcia, P. (2022). Pruritus in dialysis patients: Review and new perspectives on pathophysiology and treatment. Revista de Nephrologia, 42(1), 32-45.

Saroha, R., Sinha, S., Patel, N., Rao, R., Sharma, V., Singh, A., & Kumar, V. (2025). Impact of sleep deprivation on cognition and academic scores among first-year Indian medical undergraduates: A longitudinal study. Sleep and Health, 5(2), 67-84.https://doi.org/10.1016/j.sleh.2025.02.004

Setia, MS (2016). Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology, 61(3), 261-264.https://doi.org/10.4103/0019-5154.182410

Shadzi, M.R., Karimi, Z., Yoosefi, A., Behzadi, F., & Khajavi, M. (2024). Structural validity of the Pittsburgh Sleep Quality Index among medical students. Nature and Science of Sleep, 16, 345-356.https://doi.org/10.2147/NSS.S395781

Simanjuntak, AC (2023). Assessment of sleep quality and its relationship with daily functioning: A comprehensive review. Sleep Medicine Reviews, 52(8), 101-115.https://doi.org/10.1016/j.smrv.2023.101633

Skrzypczak, T., Grzeszczak, W., & Korbut, R. (2024). Identification and management of CKD-associated pruritus. Therapeutics and Clinical Risk Management, 20(12), 1-18.https://doi.org/10.2147/TCRM.S451234

Sugiyono. (2021). Quantitative, qualitative, and R&D research methods (2nd ed.). Alfabeta.

Sugiyono. (2023). Business research methods: Quantitative, qualitative, combination, and R&D approaches (3rd ed.). Alfabeta.

Sukmawati, S., Gede, IP, & Putra, IK (2021). Validation of Pittsburgh Sleep Quality Index in assessing sleep quality among adults in Indonesia. Asian Journal of Sleep Medicine, 3(1), 45-56.

Sukul, N., Speyer, E., Berns, J. S., & Wasse, H. (2023). Chronic kidney disease-associated pruritus and quality of life. Nature Reviews Nephrology, 17(7), 448-462.https://doi.org/10.1038/s41581-021-00429-z

Suraj, A., Lawan, B., & Kwami, AS (2025). Exploring the relationship between sleep quality and mental health among medical students in Gombe State University, Nigeria: A quantitative study. GSC Biological and Pharmaceutical Sciences, 31(3), 292-303.https://doi.org/10.30574/gscbps.2025.31.3.0241

Telzer, E. H., Fuligni, A. J., Lieberman, M. D., & Mietus-Snyder, M. (2013). The quality of adolescents' peer relationships modulates neural sensitivity to risk taking. Social Cognitive and Affective Neuroscience, 8(2), 148-156.https://doi.org/10.1093/scan/nss017

Yaghmour, S.A., Alotaibi, A., Almutairi, H., & Almihaidib, A. (2023). Poor sleep quality and mental health outcomes in medical students. Journal of Medical Education and Curricular Development, 10, 1-10.

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Published

2025-11-22

How to Cite

Fazriani, P., Arhamni, A., & Siregar, L. (2025). The Relationship Between Chronic Kidney Disease and the Severity of Pruritus in Patients Undergoing Hemodialysis at Royal Prima General Hospital in Medan. International Journal of Health and Pharmaceutical (IJHP), 5(4), 795–810. https://doi.org/10.51601/ijhp.v5i4.483

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