Uremic Pruritus Evaluation and Treatment

Excerpt

Uremic pruritus, also called chronic kidney disease-associated pruritus (CKD-aP), refers to itching related to CKD and end-stage renal disease (ESRD). It is commonly defined as the daily or near-daily experience of itch in the absence of a primary dermatologic finding. It is a common symptom that causes significant discomfort to patients with ESRD. However, other disease conditions that cause itchings, such as eczema, liver disease, atopy, and thyroid diseases, should be excluded before diagnosing uremic pruritus.

More than 40% of hemodialysis patients suffer from chronic pruritus, and half tend to have generalized pruritus. The underlying pathogenic mechanism of CKD-aP remains obscure. Histamine, parathormone, magnesium, and calcium have been associated with pathogenesis. Newer studies are looking into opioid-receptor abnormalities and microinflammation as potential causes of CKD-aP, although more data is required.

Pruritus could be extremely difficult to manage, as treatment options are limited. Stepwise management is recommended by initiating with emollients and gabapentin or phototherapy. More novel options, such as μ-opioid-receptor—antagonists or κ-opioid-receptor agonists, may be chosen in refractory cases. In advanced cases, patients could undergo transplantation, as a successful renal transplant will relieve patients from CKD-aP.