Uremic pruritus
Mettang T, Kremer A (2015)
Publication Type: Journal article
Publication year: 2015
Journal
Book Volume: 87
Pages Range: 685-91
Journal Issue: 4
DOI: 10.1038/ki.2013.454
Abstract
Uremic pruritus or chronic kidney disease-associated pruritus (CKD-aP) remains a frequent and compromising symptom in patients with advanced or end-stage renal disease, strongly reducing the patient's quality of life. More than 40% of patients undergoing hemodialysis suffer from chronic pruritus; half of them complain about generalized pruritus. The pathogenesis of CKD-aP remains obscure. Parathormone and histamine as well as calcium and magnesium salts have been suspected as pathogenetic factors. Newer hypotheses are focusing on opioid-receptor derangements and microinflammation as possible causes of CKD-aP, although until now this could not be proven. Pruritus may be extremely difficult to control, as therapeutic options are limited. The most consequential approaches to treatment are: topical treatment with or without anti-inflammatory compounds or systemic treatment with (a) gabapentin, (b) ?-opioid receptor antagonists and ?-agonists, (c) drugs with an anti-inflammatory action, (d) phototherapy, or (e) acupuncture. A stepwise approach is suggested starting with emollients and gabapentin or phototherapy as first-line treatments. In refractory cases, more experimental options as ?-opioid-receptor-antagonists (i.e., naltrexone) or ?-opioid-receptor agonist (nalfurafine) may be chosen. In desperate cases, patients suitable for transplantation might be set on 'high urgency'-status, as successful kidney transplantation will relieve patients from CKD-aP.
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Germany (DE)How to cite
APA:
Mettang, T., & Kremer, A. (2015). Uremic pruritus. Kidney International, 87(4), 685-91. https://doi.org/10.1038/ki.2013.454
MLA:
Mettang, Thomas, and Andreas Kremer. "Uremic pruritus." Kidney International 87.4 (2015): 685-91.
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