Development and Validation of a Uremic Pruritus Treatment Algorithm and Patient Information Toolkit in Patients with Chronic Kidney Disease (CKD) and End Stage Kidney Disease (ESKD)

Abstract Context Uremic pruritus (UP) affects up to half of all patients with kidney disease and has been independently associated with poor patient outcomes. UP is a challenging symptom for clinicians to manage as there are no validated guidelines for its treatment. Objectives The study aimed to develop and validate an algorithm and patient information toolkit for the treatment of UP in patients with kidney disease. Methods The study involved a literature search and development of an initial draft algorithm, followed by content and face validation of this algorithm. Validation entailed three rounds of interviews with six nephrology clinicians per round. Participants assessed the relevance of each component of the algorithm, then rated a series of statements on a scale of 1-5 to assess face validity of the algorithm. After each round, the content validity index (CVI) of each algorithm component was calculated and the algorithm was revised by the study team in response to findings. This process was followed by a second study which developed and validation a patient information pamphlet and video. Results Algorithm validation participants were affiliated with three institutions and included seven physicians, four registered nurses, three nurse practitioners, three pharmacists and a dietician. The average CVI of the algorithm components across all three rounds was 0.89, with 0.80 commonly cited as the lower acceptable limit for content validation. More than 78% of participants rated each face validity statement as “Agree” or “Strongly Agree”. For the patient information tools, five clinicians and fifteen patients were included in validation. The average CVI was 1.00 for both tools, and the average face validity was 92%. Conclusion A treatment algorithm and patient information toolkit for managing UP in patients with kidney disease was developed and validated through expert review. Further research will be conducted on implementation of the treatment algorithm and evaluating patient-reported outcomes.