Pruritus in Chronic Kidney Disease: An Update

Abstract

Chronic kidney disease-associated pruritus (CKDaP) is an often under-diagnosed and under-recognized condition, despite its considerable prevalence within the chronic kidney disease (CKD) population. Universally accepted guidelines are also lacking. The true prevalence of CKDaP worldwide therefore remains unknown, although its negative impact on mortality and health-related quality of life outcomes is very clear. The pathophysiological mechanisms leading to the onset of CKDaP are only partly understood. CKDaP is currently believed to be caused by a multifactorial process, from local skin changes, metabolic alterations, the development of neuropathy and dysregulation of opioid pathways, and psychological factors. Much work has been carried out towards a more systematic and structured approach to clinical diagnosis. Various tools are now available to assess the severity of CKDaP. Many of these tools require greater validation before they can be incorporated into the guidelines and into routine clinical practice. Further efforts are also needed in order to increase the awareness of clinicians and patients so that they can identify the CKDaP signs and symptoms in a timely manner. Currently established treatment options for CKDaP focus on the prevention of xerosis via topical emollients, the optimization of dialysis management, early referral to kidney transplantation if appropriate, oral antihistamine, and a variety of neuropathic agents. Other novel treatment options include the following: topical analgesics, topical tacrolimus, cannabinoid-containing compounds, antidepressants, oral leukotrienes, opioids, and non-pharmacological alternative therapies (i.e., phototherapy, dietary supplements, acupuncture/acupressure). We provide an updated review on the evidence relating to the epidemiology, the pathophysiology, the clinical assessment and diagnosis, and the management of CKDaP.

Serum Level of Protein-Bound Uraemic Toxins in Haemodialysis Patients with Chronic Kidney Disease-Associated Pruritus: Myths and Facts

“…Undoubtedly, UTs and other potential components of the pathogenesis of pruritus may serve as a target for new antipruritic therapies. Despite numerous studies on this topic, there are still no clear guidelines for the management of patients with CKD-aP and no objective comparison of available pharmacological methods [ 48 ]. This situation leads to different choices among doctors in clinical practice, and effects are often unsatisfactory and difficult to achieve.…”

A Sustainable Solution to Skin Diseases: Ecofriendly Transdermal Patches

“…Copyright permission for reuse from the refs. [ 33 , 34 , 35 , 36 , 37 ]. The image on the lower right corner illustrates the overall structure of a patch containing backing laminate, drug-loaded adhesive matrix, and release liner.…”

Symptom perception and self‐care practice for uraemic pruritus in patients receiving haemodialysis

“…Healthcare professionals should manage uraemic pruritus effectively for patients following a clinical practice guideline (e.g., the guideline of Kidney Disease: Improving Global Outcomes). However, due to the long‐term and refractory nature of uraemic pruritus, self‐care may be a promising strategy for patients receiving haemodialysis to manage uraemic pruritus individually (Gela & Mengistu, 2018; C. C. Y. Wang et al, 2022).…”