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2015 ; 35
(4
): 383-91
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Pruritus in Kidney Disease
#MMPMID26355256
Combs SA
; Teixeira JP
; Germain MJ
Semin Nephrol
2015[Jul]; 35
(4
): 383-91
PMID26355256
show ga
Pruritus is a common and distressing symptom in patients with chronic kidney
disease. The most recent epidemiologic data have suggested that approximately 40%
of patients with end-stage renal disease experience moderate to severe pruritus
and that uremic pruritus (UP) has a major clinical impact, being associated
strongly with poor quality of life, impaired sleep, depression, and increased
mortality. The pathogenesis of UP remains largely unclear, although several
theories on etiologic or contributing factors have been proposed including
increased systemic inflammation; abnormal serum parathyroid hormone, calcium, and
phosphorus levels; an imbalance in opiate receptors; and a neuropathic process.
UP can present somewhat variably, although it tends to affect large,
discontinuous, but symmetric, areas of skin and to be most symptomatic at night.
A variety of alternative systemic or dermatologic conditions should be
considered, especially in patients with asymmetric pruritus or other atypical
features. Treatment initially should focus on aggressive skin hydration, patient
education on minimizing scratching, and optimization of the aspects of chronic
kidney disease care that are most relevant to pruritus, including dialysis
adequacy and serum parathyroid hormone, calcium, and phosphorus management. Data
for therapy specifically for UP remain limited, although topical therapies,
gabapentin, type B ultraviolet light phototherapy, acupuncture, and
opioid-receptor modulators all may play a role.
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