Pruritus in dialysis patients. Review and new perspectives

Santos-Alonso, Carlos; Maldonado, María; Villanueva, Rafael Sánchez; García, Laura Álvarez; Gallardo, Marco Antonio Vaca; Rubio, María Auxiliadora Bajo; Gilsanz, Gloria del Peso; González, Marta Ossorio; Gutiérrez, Rafael Selgas

doi:10.1016/j.nefroe.2022.02.004

Cited by 9 publications

(6 citation statements)

References 38 publications

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“…2,6 Patients with CKD-aP have a higher prevalence of neuropathy than other CKD patients, potentially implicating afferent sensory nerves as a source of the itching. 7 A decrease in KORs has been shown within the skin of CKD-aP patients which supports a potential role of the KOR in treatment. 5 The impact and interplay between these proposed mechanisms of CKD-aP are unclear and the subject of further study.…”

Section: Introductionmentioning

confidence: 63%

Difelikefalin: A New κ-Opioid Receptor Agonist for the Treatment of Hemodialysis-Dependent Chronic Kidney Disease–Associated Pruritus

Fugal

Serpa

2022

Ann Pharmacother

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Objective: To review data for difelikefalin (Korsuva) intravenous solution for management of moderate-to-severe pruritus in hemodialysis (HD) patients. Data Sources: Literature search of PubMed (January 1946-May 2022) and SCOPUS (January 1946-May 2022) was performed using the terms: Korsuva, CR845, and difelikefalin. Additional information sources include ClinicalTrials.gov, prescribing information, meeting posters, and references of identified articles. Study Selection and Data Extraction: Clinical trials and articles evaluating difelikefalin for chronic kidney disease–associated pruritis (CKD-aP) in HD patients. Data Synthesis: Difelikefalin is a peripherally acting κ-opioid receptor agonist with antipruritic effects for HD patients with moderate-to-severe CKD-aP. A phase 3 study showed significant improvement of patient itch intensity and itch-related quality of life (QOL) when compared with placebo. More patients had decreased pruritus on the 24-hour Worst Itch Intensity Numerical Rating Scale with difelikefalin (49.1%) compared with placebo (27.9%, P < 0.001). A positive effect was seen with or without use of additional antipruritic agents. Common adverse events include diarrhea, dizziness, and vomiting; there were no signs of physical dependence or centrally acting opioid effects (euphoria, hallucinations). Relevance to Patient Care and Clinical Practice: Difelikefalin reduced itch intensity and improved QOL for patients with CKD-aP. Whether the benefit is continued long-term as well as how it compares with other effective agents is currently unknown. Conclusion: Difelikefalin is the only Food and Drug Administration–approved treatment for moderate-to-severe CKD-aP with additional research into its benefit in this and other types of pruritus ongoing.

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Section: Introductionmentioning

confidence: 63%

Difelikefalin: A New κ-Opioid Receptor Agonist for the Treatment of Hemodialysis-Dependent Chronic Kidney Disease–Associated Pruritus

Fugal

Serpa

2022

Ann Pharmacother

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Section: Discussionmentioning

confidence: 99%

“…17 Still, many physicians underestimate this distressing complaint. 18,19 Several etiological factors had been investigated including xerosis, immunological factors, neurological changes, and endocrinal disturbance. 20 Many of the accumulative uremic toxins, like IS, formed from gut microbes and represent an inter-organismal crosstalk.…”

Section: Discussionmentioning

confidence: 99%

Does Indoxyl Sulfate Have a Role in Uremic Pruritus? A Laboratory and Interventional Study

Akl,

El-Eraki,

Elfallah

et al. 2023

J Cutan Med Surg

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Background: Pruritus is a common complaint in patients with end-stage renal disease. Indoxyl sulfate (IS) is a tryptophan end metabolite extremely renal excreted. Activated charcoal can interfere with IS intestinal absorption. Objectives: To evaluate the serum level of IS and the effect of activated charcoal on uremic pruritus. Materials and Methods: In all, 135 participants were divided into 2 main groups. In total, 45 normal and healthy individuals as a control group and 90 patients on regular hemodialysis; 45 of these patients had uremic pruritus and the other 45 were not complaining of uremic pruritus. Serum IS was measured. Activated charcoal was used by patients with uremic pruritus. The severity of pruritus and Dermatology Life Quality Index (DLQI) were assessed. Results: The serum IS was significantly elevated in uremic patients than in control subjects ( P < .001) and significantly elevated in uremic patients without pruritus ( P < .001). Furthermore, there were positive significant correlations between the serum IS and both severity of pruritus ( P < .001) and DLQI ( P < .001). After activated charcoal usage, there was a significant decrease in IS level with the improvement of pruritus and quality of life of patients. Conclusions: IS may play a role in uremic pruritus. Activated charcoal could be considered a treatment for uremic pruritus.

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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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Pruritus in dialysis patients. Review and new perspectives

Cited by 9 publications

References 38 publications

Difelikefalin: A New κ-Opioid Receptor Agonist for the Treatment of Hemodialysis-Dependent Chronic Kidney Disease–Associated Pruritus

Difelikefalin: A New κ-Opioid Receptor Agonist for the Treatment of Hemodialysis-Dependent Chronic Kidney Disease–Associated Pruritus

Does Indoxyl Sulfate Have a Role in Uremic Pruritus? A Laboratory and Interventional Study

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

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