Uraemic Pruritus

Abstract

Pruritus is a common complication of end-stage renal disease (ESRD), affecting about one-third of dialysis patients. It is a chronic, unpleasant symptom with a strong negative impact on patients' quality of life, often inducing sleeplessness and mood disorders. Recent data show that it is also associated with increased mortality. The pathogenesis of uraemic pruritus (UP) is multifactorial. Triggering factors may include uraemia-related abnormalities (particularly involving calcium, phosphorus and parathyroid hormone metabolism), accumulation of uraemic toxins, systemic inflammation, cutaneous xerosis, and common co-morbidities such as diabetes mellitus and viral hepatitis. Recent findings suggest that the neurophysiology of itch is similar to that of pain; this has led to the hypothesis that the two phenomena also closely interact in ESRD patients, who often also experience uraemic neuropathy. The management of UP needs to address several different issues, such as optimization of dialysis efficacy and skin hydration, and correction of calcium-phosphorus metabolism abnormalities. A wide range of antipruritic drugs have been suggested for the treatment of UP, although most of them have only been tested in small, uncontrolled trials, which have yielded conflicting results. Antihistamines are now known to have little or no efficacy, although they are still often prescribed. Novel neurotropic drugs such as gabapentin, along with opioid receptor modulators such as nalfurafine, appear to be effective and well tolerated, but their efficacy has not yet been directly compared. Finally, physical therapies, including UV radiation, may also have a role in patients with refractory symptoms.

Uraemic Pruritus: Relief of Itching by Gabapentin and Pregabalin

“…The available treatments for uraemic pruritus have been recently reviewed in detail [8]. Antihistamines are commonly used based upon their effect on urticarial itch.…”

Comparison of high-flux hemodialysis with hemodialysis filtration in treatment of uraemic pruritus: a randomized controlled trial

“…Serum histamine levels have been shown to be elevated in ESRD patients with itching [40]. Histamine is served as a therapeutic target for UP, and oral antihistamines is also used to relieve UP discomfort [6]. A recent study discovered that hemodiafiltration significantly decreased the IL-6 level in patients with ESRD in comparison with conventional dialysis [41].…”

“…It is noted that uremic pruritus (UP) usually appears before starting hemodialysis (HD) treatment and gradually aggravates [5]. UP is often generalized or localized to the arms, head, back and abdomen, and is clinically presented by daily itching bouts at symmetrical distribution and exacerbating at night [6]. Pruritus is increasing intensity with the deterioration of the disease [6].…”

“…UP is often generalized or localized to the arms, head, back and abdomen, and is clinically presented by daily itching bouts at symmetrical distribution and exacerbating at night [6]. Pruritus is increasing intensity with the deterioration of the disease [6]. Despite its high incidence among ESRD patients, the pathophysiology of UP is not fully known.…”

“…Treatment with ultraviolet B also involves many adverse complications including tanning of the skin, maculopapular eruption, photosensitivity, erythema and potential carcinogenic effects [10]. In addition, several therapies such as oral antihistamines, naltrexone/nalbuphine, thalidomide and ondansetron are in use, yet UP is refractory to them [6]. The results of different studies have methodological inconsistencies, so that the best treatment options are still uncertain [11].…”