Chronic Kidney Disease-Associated Pruritus: A Review

Makar, Maria; Smyth, Brendan; Brennan, Frank

doi:10.1159/000518391

Cited by 22 publications

(21 citation statements)

References 93 publications

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“…Pruritus is associated with impaired QOL domains, particularly sleep, mood and social functioning 150 , and increased risks of death and HD transfer 151 . Although the pathogenesis of pruritus remains largely unknown, it is no longer thought to be purely histamine-mediated but rather to result from a complex crosstalk between dermal mast cells, epidermal keratinocytes, T helper 1 lymphocytes and nerve fibres 152 .…”

Section: Global Patient-reported Pd Outcomesmentioning

confidence: 99%

Epidemiology of peritoneal dialysis outcomes

et al. 2022

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Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.

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Section: Global Patient-reported Pd Outcomesmentioning

confidence: 99%

Epidemiology of peritoneal dialysis outcomes

et al. 2022

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“…Pruritus. Uremic pruritus affects ,55% of people receiving dialysis, and multiple pathways (both central and peripheral) have been implicated in its pathogenesis (43). Gabapentinoids are first-line pharmacotherapy (11).…”

Section: Cannabinoids and Symptoms Associated With Kidney Failurementioning

confidence: 99%

Cannabinoids for Symptom Management in Patients with Kidney Failure

Worth

O’Hara

Agarwal

et al. 2022

CJASN

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People with kidney failure can experience a range of symptoms that lead to suffering and poor quality of life. Available therapies are limited, and evidence for new treatment options is sparse, often resulting in incomplete relief of symptoms. There is growing interest in the potential for cannabinoids, including cannabidiol and tetrahydrocannabinol, to treat symptoms across a wide range of chronic diseases. As legal prohibitions are withdrawn or minimized in many jurisdictions, patients are increasingly able to access these agents. Cannabinoid receptors, CB1 and CB2, are widely expressed in the body, including within the nervous and immune systems, and exogenous cannabinoids can have anxiolytic, anti-emetic, analgesic and anti-inflammatory effects. Considering their known physiological actions and successful studies in other patient populations, cannabinoids may be viewed as potential therapies for a variety of common symptoms affecting those with kidney failure, including pruritus, nausea, insomnia, chronic neuropathic pain, anorexia, and restless legs syndrome. In this review, we summarize the pharmacology and pharmacokinetics of cannabinoids, along with what is known about the use of cannabinoids for symptom relief in those with kidney disease, and the evidence available concerning their role in management of common symptoms. Presently, while these agents show varying efficacy with a reasonable safety profile in other patient populations, evidence-based prescribing of cannabinoids for people with symptomatic kidney failure is not possible. Given the symptom burden experienced by individuals with kidney failure, there is an urgent need to understand the tolerability and safety of these agents in this population, which must ultimately be followed by robust, randomized controlled trials to determine if they are effective for symptom relief.

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“…Apart from changes in GFR, patients with CKD may also be at risk for pruritus due to dysregulation of calcium, phosphate, and parathyroid hormone (PTH) homeostasis or increased activation of inflammatory pathways. 4–6 Existing evidence to support these theories is either inconsistent, as is the case with markers of mineral metabolism, 7–11 or, as for inflammatory pathways, has yet to be explored in the CKD patient population. Finally, there is a growing appreciation that social and psychological determinants contribute to symptom burden in chronic disease, both the experience of symptoms and a patient's ability to cope with them.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors for Pruritus in Patients with Nondialysis CKD

Wulczyn

Rhee

Myint

et al. 2023

CJASN

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Background:Pruritus is a common symptom experienced by patients with nondialysis CKD, but risk factors for incident pruritus in this patient population have not been evaluated.Methods:We identified 1,951 participants with CKD in the Chronic Renal Insufficiency Cohort Study without pruritus at the baseline assessment. Pruritus was assessed by the Kidney Disease Quality of Life-36 instrument, and moderate-to-severe pruritus was defined as a response of 3 or higher on a Likert scale of 1 to 5. We used time-updated multivariable joint models to evaluate the association of patient clinical characteristics, eGFR, and laboratory parameters with incident pruritus.Results:Over a median follow-up of 6 years, 660 (34%) participants developed incident moderate-to-severe pruritus, with a higher incidence rate observed among participants with more advanced CKD. In multivariable models, the hazard ratio (95% CI) for pruritus associated with a 10 mL/min/1.73 m2lower eGFR was 1.16 (1.10 - 1.23). Older age (≥65 years), higher body mass index, diabetes, current smoking, opioid use, depressive symptoms, and serum parathyroid hormone were also associated with a higher risk of incident pruritus, while low serum calcium (<9 mg/dL) was associated with a lower risk (allp<0.05). Serum phosphate was not associated with incident pruritus in the primary analysis.Conclusions:A substantial proportion of patients with nondialysis CKD develop moderate-to-severe pruritus. While lower eGFR is associated with the risk of pruritus, other comorbidities, particularly depressive symptoms, are potential risk factors.

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Chronic Kidney Disease-Associated Pruritus: A Review

Cited by 22 publications

References 93 publications

Epidemiology of peritoneal dialysis outcomes

Epidemiology of peritoneal dialysis outcomes

Cannabinoids for Symptom Management in Patients with Kidney Failure

Incidence and Risk Factors for Pruritus in Patients with Nondialysis CKD

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