关键词: 腹膜透析, 皮肤瘙痒, 焦虑, Duo 氏改良瘙痒评分量表, Zung 氏焦虑自评量表

Abstract: Objective:To explore the clinical, biochemical, and psychosocial correlates of uremic pruritus (UP) in peritoneal dialysis (PD) patients in Xinjiang, China. Methods:A retrospective cross⁃sectional study, we enrolled 708 PD patients from 20 medical centers in Xinjiang between October 2023 and October 2024. Demographic data, dialysis⁃related indicators, and laboratory parameters were collected as baseline information. The Duo Modified Pruritus Score (DUO⁃MPS) and Zung Self⁃Rating Anxiety Scale (SAS) were used to quantify the severity of pruritus and anxiety risk, respectively, for patient stratification. Ordinal logistic regression analysis was performed to identify the influencing factors of UP. Anxiety risk was stratified into three equal intervals based on raw SAS scores. Results:There were no significant differences in baseline characteristics such as age, gender, ethnicity, and dialysis duration among patients in different UP severity groups. However, significant differences were observed in serum phosphorus levels (P=0.036), serum creatinine levels (P=0.011), and eGFR (P=0.019) across different UP severity groups. The proportion of moderate-to-severe UP increased with the elevation of anxiety risk (3.9%, 8.7%, 17.7%; χ²=30.975, P<0.001). Multivariate ordinal logistic regression analysis showed that independent factors associated with aggravated UP included anxiety (high anxiety risk group: OR=3.37, P<0.001; moderate anxiety risk group: OR=1.64, P=0.010), elevated serum creatinine (per 1 μmol/L increase: OR=1.01, P=0.012), and elevated serum phosphorus (per 1 mmol/L increase: OR=1.38, P=0.024). Smoking cessation for ≤1 year (OR=0.40, P=0.005) might be a protective factor. After adjusting for confounding factors including anxiety, smoking status, serum creatinine, and serum phosphorus, improved serum magnesium levels exhibited a weak protective effect (per 0.1 mmol/L increase; OR=0.99, P=0.021). Conclusion:There is a graded progressive relationship between anxiety risk and UP severity in multi⁃center PD patients in Xinjiang. High anxiety risk, elevated serum creatinine, and elevated serum phosphorus promote the aggravation of UP, while recent smoking cessation and appropriate increase in serum magnesium may help reduce the risk of UP. Routine SAS stratification assessment should be carried out in clinical practice. For patients with a SAS score >40, a comprehensive management strategy combining psychological intervention with mineral metabolism optimization is recommended, which may reduce the burden of UP.

Key words: peritoneal dialysis, uremic pruritus, anxiety, Duo Modified Pruritus Score, Zung Self?Rating Anxiety Scale