What is the clinical significance of uremic pruritus in patients with kidney disease?

Pruritus is a common and troublesome symptom among patients with end-stage kidney disease. The pathophysiology is incompletely understood, and it is often difficult to eradicate, although symptoms can usually be mitigated.

Uremic pruritus has been shown to repeatedly reduce quality of life, to contribute to other symptoms (especially poor sleep) that further impair quality of life, to be associated with depression, to be an independent predictor of mortality, and to lead to other poor patient outcomes.

What is the clinical presentation of uremic pruritus?

Clinical presentation of pruritus in patient with chronic kidney disease patients varies greatly from patient to patient.

Majority of patients have itching daily or nearly daily, and most patients had itching that affected large, discontinuous, but bilateral and symmetric areas of the skin.

What are the common factors associated with pruritus?

The clinical presentation of the patients varies significantly with regard to the circumstances that trigger or aggravate pruritus; common factors reported include heat, dialysis, stress, cold, physical activity, and showering. Unfortunately, most patients affected by pruritus will continue to have the symptom for months to years.

How can uremic pruritus be evaluated?

• Obtain objective information about the severity to track the response to therapy
• Pruritus is typically assessed via patient-reported outcomes (PROs)
• Several PRO scales are available for the assessment of pruritus intensity including both unidimensional measures that address one symptom at a time with one scale and multidimensional measures that track more than one symptom, change in symptoms over time or more than one assessment of a particular symptom

How can uremic pruritus be treated?

Clinicians have tested various topical and systemic treatments for pruritus.

• The cornerstone of uremic pruritus therapy is adequate skin hydration.
• Skin hydration with aqueous cream emollient and baby oil both have been shown to reduce skin dryness and the severity of uremic pruritus effectively and to improve patient quality of life when applied two to four times daily.
• Various systemic therapies are currently used for the treatment of uremic pruritus.
• Gabapentin and pregabalin have been shown to effective for the treatment of pruritus.
• Antihistamines are commonly used to treat pruritic symptoms in patients with chronic kidney disease.
• Phototherapy and acupuncture have also been sued in the management of uremic pruritus.

References

1. Combs SA, Teixeira JP, Germain MJ. Pruritus in kidney disease. Semin Nephrol. 2015; 35: 383-391.