Uremic pruritus, also called chronic kidney disease (CKD)-associated pruritus (CKD-aP), is a common and debilitating symptom experienced by patients with CKD and end-stage renal disease (ESRD), which causes significant discomfort to patients. The condition is characterized by itching related to CKD and end-stage renal disease (ESRD). Uremic pruritus is commonly defined as the daily or near-daily experience of itching without a primary dermatologic finding. It is a common symptom that causes significant discomfort to patients with ESRD. However, other conditions that cause itching, such as eczema, liver disease, atopy, and thyroid diseases, should be excluded before diagnosing uremic pruritus.
More than 40% of hemodialysis patients suffer from chronic pruritus, with half experiencing generalized pruritus. The underlying pathogenic mechanism of CKD-aP remains obscure. Histamine, parathyroid hormone (PTH), magnesium, and calcium have been associated with its pathogenesis. Newer studies are evaluating opioid-receptor abnormalities and microinflammation as potential causes of CKD-aP, although more data are required.
Pruritus can be extremely difficult to manage due to limited treatment options. Stepwise management is recommended, starting with topical emollients, gabapentin, and phototherapy. More novel options, such as μ-opioid receptor antagonists or κ-opioid receptor agonists, may be chosen in refractory cases. In advanced cases, patients may undergo transplantation, as a successful renal transplant will relieve patients from CKD-aP.
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