Development of a Multidimensional Assessment Tool for Uremic Pruritus in Dialysis Patients (UP-Dial)

Abstract

Background

Dialysis patients with uremic pruritus (UP) have a significantly impaired quality of life. To assess the therapeutic effect of UP treatments, a well-validated comprehensive and multidimensional instrument needed to be established.

Objectives

To develop and validate a multidimensional scale assessing the UP in dialysis patients: Uremic Pruritus in Dialysis Patients (UP-Dial).

Methods

The development and validation of the UP-Dial instrument was conducted in four phases: (1) item generation, (2) development of pilot questionnaire, (3) refinement of questionnaire with patient recruitment, and (4) psychometric validation. Participants completed the UP-Dial, the visual analogue scale (VAS) of UP, the Dermatology Life Quality Index (DLQI), the Kidney Disease Quality of Life-36 (KDQOL-36), the Pittsburgh Sleep Quality Index (PSQI), and the Beck Depression Inventory (BDI) during May 15, 2012 to November 30, 2015.

Results

The 27-item pilot UP-Dial was generated with 168 participants completing the pilot scale. After factor analysis was performed, the final 14-item UP-Dial encompassed the structure of three domains: signs and symptoms, psychosocial, and sleep. Face and content validity were satisfied through the item generation process and review of experts. The psychometric analysis demonstrated that the UP-Dial had good convergent validity and discriminant validity. The UP-Dial was significantly correlated (Spearman rank, [95% CI]) with the VAS-UP (0.76 [0.69 to 0.83]), DLQI (0.78 [0.71 to 0.85]), KDQOL-36 (-0.86 [-0.91 to -0.81]), PSQI (0.85 [0.80 to 0.89]), and BDI (0.70 [0.61 to 0.79]). The UP-Dial revealed excellent internal consistency (Cronbach's α 0.90 [0.87 to 0.92]) and reproducibility (intraclass correlation 0.95 [0.90 to 0.98]).

Conclusions

The UP-Dial is valid and reliable for assessing UP among dialysis patients. Future research should increase the cross-cultural adaptation and translation of the scale to other languages.

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