Reliability and validity of the Persian version of 5-D itching scale among patients with chronic kidney disease

Translation, Reliability and Validity of the Greek Version of the 5-D Itch Scale in People With Chronic Kidney Disease Receiving Haemodialysis

BACKGROUND

Chronic kidney disease-associated pruritus (CKD-aP) is a condition that causes significant distress to people undergoing haemodialysis (HD). It significantly impacts individuals' sleep habits, everyday activities, social interactions, mental health and overall quality of life. A number of tools have been developed to evaluate the severity of pruritus. The 5-D itch scale is one of the most widely used tools for assessing various aspects of pruritus. In Greece, there is no validated and culturally adapted tool to assess pruritus in individuals with CKD receiving HD. Hence, this study aimed to evaluate the reliability and validity of the Greek version of the 5-D itch scale.

MATERIALS AND METHODS

The English version of the 5-D itch scale was translated into the Greek language according to international guidelines and was cross-culturally adapted in people with CKD on HD (Ν = 120). The intraclass correlation coefficient was used to assess the reliability of the instrument after the test-retest procedure (n = 30). Confirmatory factor analysis was conducted in order to test how well the 5-D itch scale one-factor model fits the data. Internal consistency reliability was determined by the calculation of Cronbach's alpha coefficient (n = 120). Convergent validity was tested through the correlation with the Kidney Disease Quality of Life Instrument Short-Form (KDQOL-SF) scale and the visual analogue scale. Statistical significance was set at p < 0.05. Analyses were conducted using IBM SPSS Statistics for Windows, version 26.0 (released 2019, IBM Corp., Armonk, NY).

RESULTS

The sample consisted of 120 people with CKD receiving HD (60.0% males, n = 72), with a mean age of 65.7 years (SD ±13 years), of whom 80 individuals reported CKD-aP. Regarding confirmatory factor analysis, this solution had a good model fit (χ2/df = 1.93; root mean square error of approximation (RMSEA) = 0.03; comparative fit index (CFI) = 0.92; Tucker Lewis index (TLI) = 0.93 and standardized root mean square residual (SRMR) = 0.05). The intraclass correlation coefficients were significant (p < 0.001) in all items and over 0.85. Cronbach's alpha for the 5-D itch scale total score was 0.75, indicating good reliability. The reliability index had minor changes after removing its items; thus, no item needed to be removed from the scale. The correlation of the 5-D itch scale with the KDQOL-SF (p = 0.002) indicates the good convergent validity of the scale.

CONCLUSION

The Greek version of the 5-D itch scale is an instrument with good reliability and validity, possessing the potential to be utilised by healthcare professionals for the purpose of the assessment of CKD-aP among Greek-speaking people undergoing HD.

The Efficacy of Zinc Gluconate Supplementation in the Improvement of Malnutrition Indices and Skin Abnormalities in Hemodialysis Patients: A Randomized Clinical Trial

Background

Hemodialysis patients often suffer from several complications such as malnutrition and skin abnormalities. We hypothesized that zinc supplementation may improve these complications. The aim of the present study was to examine the effects of zinc gluconate supplementation on malnutrition and skin abnormalities.

Methods

In this parallel randomized, double-blind, clinical trial, patients in the zinc group received 210 mg zinc gluconate (equivalent to 30 mg elemental zinc) per day. Skin abnormalities (i.e. xerosis and pruritus), body composition, anthropometric variables, handgrip strength, and appetite (including hunger, fullness, desire to eat, and prospective food consumption) were measured at the beginning and end of the study.

Results

Eighty-seven hemodialysis patients were randomly assigned to the zinc (n = 44) or placebo (n = 43) group for 12 weeks, After this period, 75 patients (N = 38 in the zinc group and 37 in the placebo group) remained in the study. In this study, no specific side effects of zinc supplementation were observed and twelve participants were lost to follow-up (n = 6 in each group) because of migration, kidney transplantation, death, dialysis access infection, and personal reasons. Zinc supplementation had beneficial effects on hunger) 95% CI: 9/55 (3/67-15/42)), desire to eat) 95% CI: 7/03 (1/82-12/24)), and prospective food consumption) 95% CI: 3/46 (0/3-14/1)) compared with placebo. Also, zinc improved pruritus) 95% CI: -0/52 (-0/82 to - 0/22)). We observed no changes in body composition, anthropometric variables, handgrip strength, and xerosis in the zinc group compared with the placebo.

Conclusions

This randomized clinical trial showed that zinc supplementation yielded beneficial effects on appetite and pruritus in hemodialysis patients.

Evaluation of the Efficacy and Safety of Mirtazapine in the Treatment of Uremic Pruritus in Hemodialysis Patients: A Randomized, Double-blind, Placebo-controlled Clinical Trial

Objective

Uremic pruritus (UP) is a prevalent and debilitating condition experienced by patients undergoing hemodialysis, influenced by multiple underlying mechanisms. Despite the availability of various treatment options, many patients still endure significant pruritus. This double-blind, placebo-controlled clinical trial aims to assess and compare the safety and efficacy of mirtazapine and hydroxyzine in treating UP and improving sleep quality in hemodialysis patients.

Methods

Twenty-seven patients in the mirtazapine group received 15 mg/night (7.5 mg for the first two nights) with a hydroxyzine placebo, while 28 patients in the hydroxyzine group received 25 mg/night (12.5 mg for the first two nights) with a mirtazapine placebo for 2 weeks. UP was assessed using the 5D-itch scale, and sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) at baseline, weeks 2, 3, and 4. Adverse effects were recorded using the Antidepressant Side Effect Checklist at each visit from baseline to week 2.

Findings

UP ratings based on the 5D-itch scale decreased for both groups, with a more significant reduction in the mirtazapine group (P = 0.04). The mirtazapine group also showed a significant improvement in the PSQI compared to hydroxyzine (P = 0.01). Dry mouth was the only notable adverse effect, occurring more frequently in the mirtazapine group (P = 0.02).

Conclusion

This study suggests that short-term treatment with mirtazapine is more effective than hydroxyzine in reducing the severity of UP and improving sleep quality for patients undergoing hemodialysis.

Effectiveness of topical gabapentin cream in treating pruritus in dialysis patients: A randomized controlled trial

INTRODUCTION

Gabapentin is an antiepileptic drug that alleviates neuropathic pain. Its oral use reduces the intensity of pruritus in patients receiving chronic dialysis therapy. However, it could lead to toxicity because of the patients' renal deficiency. In this study, we assessed the use of gabapentin topical in treating pruritus in dialysis patients.

METHODS

This randomized, triple-blinded trial was performed on 80 patients divided into two groups randomly (40 in each group). In intervention group, 92.5% of the patients were on hemodialysis. Patients in intervention and control groups were provided with 5% gabapentin and placebo topical creams every 2 weeks for a month. Both Visual Analog Scale and 12-item Pruritus Severity Score questionnaire were used to evaluate itching intensity and score before treatment, a month, and 2 months after starting treatment in both groups. In addition, the effect of itching on quality of life was investigated with the same questionnaire.

FINDINGS

Eighty patients (40 in each group) participated in our study. No complication was found in our intervention group. Itching score significantly decreased after a month and 2 months of follow-up in intervention group (p < 0.001).

DISCUSSION

Our results showed that 5% gabapentin topical cream can be effective in reducing itching in different areas of the body. None of our patients reported complications.

Reliability and Fall-Risk Predictability of the Short Form of the Fullerton Advanced Balance Scale in Iranian Older Adults

Recently, a short form of the Fullerton Advanced Balance (SF-FAB) scale was reported as a good predictor of falls in older adults. However, we found no evidence regarding its reliability in non-American older adults. Therefore, we aimed to analyze the reliability and homogeneity of the SF-FAB scale to measure postural balance in Iranian older adults. Eighty-five community-dwelling older adults (70.75 ± 4.97 years) performed the SF-FAB test on two occasions 1 week apart. In both instances, four raters assessed the performance on the test. The SF-FAB scale (mean total score: 12.46 ± 3.53) revealed acceptable internal consistency (Cronbach's α = .77), excellent intrarater reliability (intraclass correlation coefficient = .94-.99), and excellent interrater reliability (intraclass correlation coefficient = .92-.99). The overall prediction success rate was 83.5% with correctly classifying 95.6% of nonfallers and 35.3% of fallers. The SF-FAB scale can provide a quick screen of balance status in older adults to trigger referral to clinicians for a more comprehensive assessment.