Chronic Kidney Disease-Associated Pruritus: A Glance at Novel and Lesser-Known Treatments

Abstract

Chronic kidney disease-associated pruritus (CKD-aP), also known as uremic pruritus, has been associated with increased mortality and lower quality of life among patients with chronic kidney disease (CKD). The relentless nature of the condition is mainly due to its diverse and complex etiologies, which are still being studied. Despite the introduction of many agents to treat it, the resolution rates of CKD-aP still remain unsatisfactory. This study sought to review the lesser-known/novel treatments and establish a relationship between their mechanism of action and the proposed etiologies implicated in CKD-aP. We also discuss the role of dialysis modification in managing CKD-aP.A decent proportion of the reviewed studies have proposed that the agents analyzed in them act through hampering inflammation. Interestingly, the results of two agents alluded to the role of dysbiosis in CKD-aP. The addition of hemoperfusion to the dialysis regimen of patients with CKD-aP improved the severity of their symptoms.The featured treatments could be tried in patients with intractable symptoms. However, additional research is needed to confirm the findings reported in these studies. A better understanding of the pathologic mechanisms is required to help guide the development of agents that can better treat CKD-aP.

Pathogenesis and Treatment of Pruritus Associated with Chronic Kidney Disease and Cholestasis

“…Accumulation of P, Ca, Al, and Mg can contribute to pruritus [ 37 , 38 , 39 ]. Hypercalcemia and hyperphosphatemia were identified as independent risk factors for CKD-associated pruritus [ 9 ].…”

“…Unfortunately, treatment guidelines for CKD-associated pruritus have not yet been established. Treatment methods such as emollients, antihistamines, topical steroids, and ultraviolet therapy are a few of the agents currently being used [ 37 ]. These treatments are generally helpful in treating itching from various causes and can be tried first because as they do not have serious side effects.…”

Effectiveness of omega-3 fatty acid supplementation for pruritus in patients undergoing hemodialysis

“…Although the definite mechanisms for uremic CKD-aP have not been determined, some pathologic mechanisms are proposed for uremic CKD-aP such as increasing oxidants and inflammatory processes, loss of serum anti-oxidants in CKD patients during HD, imbalance of ions and electrolytes, and inability to excrete nitrogen products and other waste materials ( 11 ). Recent studies suggested using anti-inflammatory and antioxidant agents could lead to reduce pruritus ( 12 ).…”

Comparative efficacy of acupuncture point stimulation treatments for dialysis patients with uremic pruritus: a systematic review and network meta-analysis

“…Antihistamines, gabapentin, and opioid-receptor modulators are the current treatments for UP, but these show variable therapeutic responses and potential side effects in patients with CKD (4,6). Many adjuvant therapies including phototherapy, acupuncture, diet supplement, and sodium thiosulphate injection have recently been reported (6)(7)(8).…”