Clinical management of chronic kidney disease-associated pruritus: current treatment options and future approaches

Lipman, Zoe M.; Paramasivam, Vijayakumar; Yosipovitch, Gil; Germain, Michael J.

doi:10.1093/ckj/sfab167

Cited by 22 publications

(15 citation statements)

References 79 publications

(65 reference statements)

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“…Recently published results from the European QUALity (EQUAL) study, an ongoing, prospective, multicenter study in patients ≥65 years with an incident eGFR ≤20 mL/min/1.73 m 2 highlighted the number of symptoms and severity of symptom burden considerably worsened before dialysis initiation among advanced CKD patients, of which some improvements in cardiopulmonary symptoms, gastrointestinal symptoms, neurological symptoms, emotional symptoms, sleep disorders, and fatigue were observed while sexual symptoms (e.g., "decreased interest in sex" and "difficulties in becoming sexually aroused"), integumentary, and musculoskeletal symptoms worsened following dialysis initiation or did not change at all [73]. Table 3 outlines some of the common symptoms that may be experienced by older PD patients and potential management strategies to address these symptoms [15,[74][75][76][77][78][79][80][81].…”

Section: Addressing Symptom Burden In Older Pd Patientsmentioning

confidence: 99%

Delivering Personalized, Goal-Directed Care to Older Patients Receiving Peritoneal Dialysis

Wu¹,

Poulikakos²,

Hurst³

et al. 2023

Kidney Dis

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Background: An aging population living with chronic kidney disease and progressing to kidney failure, subsequently receiving peritoneal dialysis (PD) is growing. A significant proportion of these patients are also living with multi-morbidities and some degree of frailty. Recent practice recommendations from the International Society of Peritoneal Dialysis advocate for high-quality, goal-directed PD prescription, and the Standardized Outcomes of Nephrology-PD initiative emphasized the need for an individualized, goal-based care approach in all patients receiving PD treatment. In older patients, this approach to PD care is even more important. A frailty screening assessment, followed by a comprehensive geriatric assessment (CGA) prior to PD initiation and when dictated by change in relevant circumstances is paramount in tailoring PD care and prescription according to the needs, life goals, as well as clinical status of older patients with kidney failure. Summary: Our review aimed to summarize the different dimensions to be taken into account when delivering PD care to the older patient – from frailty screening and CGA in older patients receiving PD to employing a personalized, goal-directed PD prescription strategy, to preserving residual kidney function, optimizing blood pressure (BP) control, and managing anemia, to addressing symptom burden, to managing nutritional intake and promoting physical exercise, and to explore telehealth opportunities for the older PD population. Key Messages: What matters most to older PD patients may not be simply extending survival, but more importantly, to be living comfortably on PD treatment with minimal symptom burden in a home environment and to minimize treatment complications.

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Section: Addressing Symptom Burden In Older Pd Patientsmentioning

confidence: 99%

Delivering Personalized, Goal-Directed Care to Older Patients Receiving Peritoneal Dialysis

Wu¹,

Poulikakos²,

Hurst³

et al. 2023

Kidney Dis

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“…If patients are contraindicated for difelikefalin, it is not available, or resistant disease is reported, the use of gabapentoids is suggested as alternative or additional treatment, followed by other therapies such as phototherapy or selective serotonin reuptake inhibitors, which have some evidence of efficacy in small, uncontrolled clinical trials [ 53 ].…”

Section: Quantifying Itch Intensity and The Effect Of Itching On A Pa...mentioning

confidence: 99%

Alleviating symptoms in patients undergoing long-term hemodialysis: a focus on chronic kidney disease-associated pruritus

Agarwal

Burton

Gallieni³

et al. 2022

Clinical Kidney Journal

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Since the breakthrough of kidney replacement therapy, increases in life expectancy for patients with end-stage kidney disease have been limited. However, patients have become increasingly vocal that, although mortality and life expectancy matter to them, the quality of their life, and particularly the relief of symptoms associated with their treatment, are in many cases more important. The majority of dialysis-associated symptoms and adverse effects do not currently have any approved treatments in this patient population, with the few treatments that are available used off-label, frequently without proven efficacy, yet still potentially adding further adverse effects to patients’ current symptom burden. This article will illustrate how understanding the pathophysiology of a single, particularly burdensome symptom of dialysis (chronic kidney disease-associated pruritus) resulted in the design, development, and regulatory approval of a treatment for that symptom. The pathway described here can be applied to other symptoms associated with dialysis, meaning that if we cannot add years to patients’ lives, we can at least add life to their remaining years.

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“…7 Although new drugs are being developed to ameliorate peripheral neuropathy in patients, and methods of hemodiafiltration and hemoperfusion are being used to remove large and medium molecular weight toxins in patients with uremia, the results of treatment for itchy skin in patients with uremia undergoing chronic dialysis remain unsatisfactory. [8][9][10][11][12] Hemodiafiltration with endogenous reinfusion (HFR) is a kind of hemodiafiltration that utilizes separated convection, diffusion, and adsorption. 13 Supra-HFR hemofiltration adsorption is a new generation of clinical dialysis treatment mode, which can remove large molecules of water-soluble toxins and protein-binding toxins.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, it is believed that the mechanism of pruritus in uremia is related to the deposition of macromolecular weight toxins in uremia, immune system disorder, peripheral neuropathy, and opioid imbalance 7 . Although new drugs are being developed to ameliorate peripheral neuropathy in patients, and methods of hemodiafiltration and hemoperfusion are being used to remove large and medium molecular weight toxins in patients with uremia, the results of treatment for itchy skin in patients with uremia undergoing chronic dialysis remain unsatisfactory 8–12 . Hemodiafiltration with endogenous reinfusion (HFR) is a kind of hemodiafiltration that utilizes separated convection, diffusion, and adsorption 13 .…”

Section: Introductionmentioning

confidence: 99%

Early clinical observation of supra‐hemodiafiltration with endogenous reinfusion in the treatment of uremic pruritus

Zha

Shi

et al. 2023

Artificial Organs

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BackgroundTo evaluate the clinical efficacy of supra‐hemodiafiltration with endogenous reinfusion (Supra‐HFR) for pruritus in uremic maintenance hemodialysis (HD) patients and explore the possible mechanism.MethodsThis study prospectively included 60 patients with uremia who underwent maintenance hemodialysis and developed pruritus. Patients were randomly divided into a study group (30 cases) and a control group (30 cases). Patients in the study group underwent dialysis once a week with Supra‐HFR and twice a week with HD. The group received HD dialysis 3 times a week. Visual analog scales (VAS) scores, 5‐D itch scale scores, and 12‐Item Pruritus Severity Scale (12‐PSS) were used to evaluate the itching degree of patients. Quality of life was assessed using KDTA and SF‐36 scores. Blood levels of hypersensitive C‐reactive protein, calcium ion (Ca2+), phosphorus ion (P3+), free parathyroid hormone (iPTH), and β2‐microglobulin (β2‐MG) were compared between the two groups before treatment and at follow‐up 24 weeks after treatment.ResultsBefore treatment, there was no significant difference in VAS, 5‐D itch scale, and 12‐PSS score between the study group and the control group (all p > 0.05). After 24 weeks of treatment, the VAS score of the study group (2.82 ± 0.91) was significantly lower than that of the control group (7.47 ± 1.32, p < 0.001), the 5‐D itch scale score of the study group (9.47 ± 2.34) was significantly lower than that of the control group (18.53 ± 4.02, p < 0.001), the 12‐PSS score of the study group (11.20 ± 1.81) was significantly lower than that of the control group (16.47 ± 2.09, p < 0.001). KDTA of the study group (64.17 ± 8.07 vs. 47.83 ± 13.46, p < 0.001) and SF‐36 scores (65.37 ± 6.28 vs. 55.90 ± 14.28, p = 0.002) were significantly higher than that in the control group. The levels of hs‐CRP, P3+, iPTH, and β2‐MG in the study group after treatment were lower than those before treatment, and lower than those in the control group after treatment (all p < 0.05).ConclusionsThe Supra‐HFR can effectively reduce the itching symptoms of uremia patients and improve their quality of life.

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Clinical management of chronic kidney disease-associated pruritus: current treatment options and future approaches

Cited by 22 publications

References 79 publications

Delivering Personalized, Goal-Directed Care to Older Patients Receiving Peritoneal Dialysis

Delivering Personalized, Goal-Directed Care to Older Patients Receiving Peritoneal Dialysis

Alleviating symptoms in patients undergoing long-term hemodialysis: a focus on chronic kidney disease-associated pruritus

Early clinical observation of supra‐hemodiafiltration with endogenous reinfusion in the treatment of uremic pruritus

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