Pruritus Associated With Chronic Kidney Disease: A Comprehensive Literature Review.

Sanzida S Swarna,Nida Qadir,Mehreen Khan,Kashif Aziz,Tayyaba Zubair

doi:10.7759/cureus.5256

Abstract

The prevalence of pruritus in chronic kidney disease (CKD) patients has varied over the years, and some studies suggest the prevalence may be coming down with more effective dialysis. Chronic kidney disease-associated pruritus (CKD-aP), previously called uremic pruritus, is a distressing symptom experienced by patients with mainly advanced chronic kidney disease. CKD-aP is associated with poor quality of life, depression, anxiety, sleep disturbance, and increased mortality. The incidence of CKD-aP is decreasing given improvements in dialysis treatments, but approximately 40% of patients with end-stage renal disease experience CKD-aP. While the pathogenesis of CKD-aP is not well understood, the interaction between non-myelinated C fibers and dermal mast cells plays an important role in precipitation and sensory stimulation. Other causes of CKD-aP include metabolic abnormalities such as abnormal serum calcium, parathyroid, and phosphate levels; an imbalance in opiate receptors is also an important factor. CKD-aP usually presents as large symmetric reddened areas of skin, often at night. Managing CKD-aP is a challenge. Research in this area is difficult because most studies are not comparable given their small group samples, study designs, and lack of standardized study measures. The most commonly used treatment is a combination of narrow-band ultraviolet B phototherapy and a μ-opioid receptor antagonist such as naltrexone.

Highlights

BackgroundChronic kidney Disease (CKD) is a type of kidney disease in which there is a gradual loss of kidney function over a period of months or years
chronic kidney disease (CKD)-aP can occur without any skin disease or can coexist with xerosis in 50% to 80% patients [3]; or with superimposed complications of excoriation including impetigo, linear crusts, papules, ulcerations, and prurigo nodularis [4]
The prevalence of pruritus in CKD patients has varied over the years, and some studies suggest the prevalence may be coming down with more effective dialysis

Summary

Introduction

Chronic kidney Disease (CKD) is a type of kidney disease in which there is a gradual loss of kidney function over a period of months or years (more than three months). Pruritus is a highly prevalent and common condition in patients with advanced CKD and patients with end-stage renal disease on dialysis. Chronic kidney disease-associated pruritus (CKD-aP), once called uremic pruritus, mainly affects the face, chest, and limbs, and may be generalized in up to 50% of patients [2]. As Mettang et al notes, “CKD-aP remains a frequent and compromising symptom in patients with advanced or end-stage renal disease; most therapeutic trials have shown only limited success” [5]. Called end-stage renal disease, on dialysis, having moderate to severe pruritus, often feel depressed and drained, have a 17% higher mortality rate, and have a poor quality of sleep [6]. For treatment of patients with CKD-aP, gabapentin, systemic μ-receptor antagonists, κ-agonists, and ultraviolet (UV)-phototherapy are currently used [9]

Methodology

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Disclosures