Chronic Kidney Disease-Associated Pruritus

Abstract

Pruritus is a distressing condition associated with end-stage renal disease (ESRD), advanced chronic kidney disease (CKD), as well as maintenance dialysis and adversely affects the quality of life (QOL) of these patients. It has been reported to range from 20% to as high as 90%. The mechanism of CKD-associated pruritus (CKD-aP) has not been clearly identified, and many theories have been proposed to explain it. Many risk factors have been found to be associated with CKD-aP. The pruritus in CKD presents with diverse clinical features, and there are no set features to diagnose it.The patients with CKD-aP are mainly treated by nephrologists, primary care doctors, and dermatologists. Many treatments have been tried but nothing has been effective. The search of literature included peer-reviewed articles, including clinical trials and scientific reviews. Literature was identified through March 2021, and references of respective articles and only articles published in the English language were included.

Chronic Intractable Pruritus in Chronic Kidney Disease Patients: Prevalence, Impact, and Management Challenges — A Narrative Review

“…Itch can be caused by centrally acting mediators, defects in the peripheral sensory pathway, cortical hypersensitivity, decreased cortical inhibitory mechanisms, or a defective spinal cord inhibition. 35 A positive correlation between itch severity and occurrence of paresthesia in HD patients has been found. Most pruritic patients also develop peripheral sensorimotor neuropathy and dysautonomia.…”

“…12 This viral infection predisposes to development of CI, due to cholestasis, induction of interferonstimulated gene,s and elevated production of cytokines (eg, IL8) and chemokines (eg, CCL2, CXCL1, and CXCL5). 22,35 Interestingly, hepatitis B does not show a significant association with pruritus, and this has raised the question of whether the pathogenesis of pruritus differs between these two diseases.de Kroes and Smeenk found elevated serum levels of vitamin A in all 35 CKD patients included in their research. However, there was no correlation between vitamin A concentration and the presence of CKD-aP.…”

“…33 Despite these discrepancies, regular use of emollients is widely recommended for patients with CKD-aP and may improve not only dryness of the skin but also itch severity and patients' QoL. [34][35][36]…”

“…Therefore, parathyroidectomy cannot be considered a form of CKD-aP therapy, except in the case of concurrent hyperparathyroidism. 35 In some reports, reduction of itch prevalence after successful renal transplantation has been highlighted. 154,155 The biggest published study on this topic thus far, conducted on 197 renal transplant recipients, showed that in 73.7% of patients the itch disappeared completely after transplantation, while in 23.7% itch had lower intensity and only 2.6% patients did not report any improvement.…”

Chronic Kidney Disease-Associated Pruritus: A Glance at Novel and Lesser-Known Treatments

“…Raised serum calcium, parathyroid hormone (PTH), and phosphorus have also been associated with CKD-aP. The exact mechanism as to how they bring about pruritus is not well elucidated [11,13]. Dry skin has been implicated in the pathogenesis of CKD-aP through a myriad of processes such as a change in skin pH and increased urea excretion in the skin [13].…”