Essential oil massage and incident chronic kidney disease–associated pruritus in maintenance hemodialysis patients without baseline pruritus: a prospective non-concurrent before-and-after study

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Objective To compare the incidence of chronic kidney disease-associated pruritus (CKD-aP) between two consecutive care phases among maintenance hemodialysis patients without pruritus at baseline, following the addition of essential oil massage to standardized hemodialysis care and basic skin care. Methods This single-center, prospective, non-concurrent before-and-after controlled study enrolled 87 maintenance hemodialysis patients from January to December 2024. Patients in the control phase ( n = 43) received routine dialysis care and basic skin care, whereas those in the intervention phase ( n = 44) received additional essential oil massage. The primary outcome was incident pruritus. Topical ointment use was evaluated as an exploratory secondary outcome. Exploratory analyses among patients who developed pruritus during follow-up included pruritus severity assessed using the visual analog scale (VAS) and duration of ointment use. Skin-related adverse reactions were also recorded in the intervention group. Results No baseline characteristic differed statistically between the two phases; however, SMDs indicated mild imbalance in several variables. During follow-up, the incidence of pruritus was significantly lower in the intervention group than in the control group (31.8% vs. 65.1%, P = 0.002). The rate of topical ointment use was also significantly lower in the intervention group (13.6% vs. 48.8%, P < 0.001). Among patients who developed pruritus, the intervention group showed lower VAS scores and shorter duration of ointment use than the control group (both P < 0.01). Two patients (4.5%) in the intervention group developed mild local adverse reactions, all of which resolved after temporary discontinuation or symptomatic management. Conclusion The intervention phase showed a lower observed incidence of new-onset CKD-aP and less topical ointment use among maintenance hemodialysis patients without pruritus at baseline. However, because intervention exposure was completely aligned with calendar period, this study cannot distinguish an intervention effect from a seasonal effect, and the observed difference should not be interpreted as evidence of preventive benefit. Findings regarding pruritus severity among patients who developed pruritus during follow-up were exploratory.

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