Chronic Kidney Disease‐Associated Pruritus in Haemodialysis: A Mixed‐Methods Study of Symptom Burden and Patient Experience

BACKGROUND: Chronic kidney disease-associated pruritus is a common and often under-recognized symptom among people receiving haemodialysis and may substantially impair daily life and wellbeing. OBJECTIVES: To determine the prevalence and severity of pruritus in people receiving haemodialysis and to explore the lived experiences of those with moderate-to-severe pruritus. DESIGN: Explanatory sequential mixed-methods study. PARTICIPANTS: A total of 294 adults receiving haemodialysis in three dialysis centres participated in the quantitative phase. The qualitative phase included 48 participants selected from the quantitative sample who had moderate-to-severe pruritus, defined as a Five-D Itch Scale score of 12 or higher. MEASUREMENTS: Data were collected between October 2025 and January 2026. Quantitative data were collected using the Five-Dimensional Itch Scale and a sociodemographic and clinical information form developed for this study. Qualitative data were generated through at least two semi-structured interviews with each participant and analysed using reflexive thematic analysis. Integration was performed at the interpretation stage. RESULTS: The mean Five-Dimensional Itch Scale score was 8.00 ± 3.21, and moderate-to-severe pruritus prevalence was 16.3%. Multivariable analysis showed lower symptom reporting among married participants, whereas comorbidity and previous pruritus-related education were associated with higher symptom reporting. Qualitative findings indicated that pruritus was experienced as a fluctuating burden affecting sleep, daily comfort, and social roles. Participants described trial-and-error self-management strategies and expressed a need for proactive assessment, practical guidance and individualised nursing care. CONCLUSIONS: Chronic kidney disease-associated pruritus remains a multidimensional burden in haemodialysis care. Standardised assessment and person-centred nursing care may improve its recognition and management.