Pruritus in Uremic Patients: Approaches to Alleviating a Common Symptom in Chronic Kidney Disease

Abstract

Chronic kidney disease-associated pruritus (CKD-aP) is a distressing symptom that affects both dialysis and non-dialysis patients, significantly impairing their quality of life. Despite its multifactorial pathophysiology, no gold-standard treatment has been established. This review explores various therapeutic options and evaluates their effectiveness based on recent clinical studies and meta-analyses. Therapies targeting novel mechanisms have evolved in recent years. Difelikefalin, a κ-opioid receptor agonist, represents a breakthrough in systemic treatment, demonstrating efficacy with a favorable safety profile. Another opioid-based therapy, nalfurafine, has shown notable symptom relief in multiple clinical studies, with a low risk of abuse. Sertraline, an antidepressant, offers another alternative, although its delayed onset remains a limitation. Nonpharmacologic approaches are also evolving. Phototherapy, particularly UV-B therapy, modulates the immune response, reduces inflammation, and effectively alleviates itching in hemodialysis patients. Personalized treatment strategies are crucial, as responses vary among patients. Further research, including comparative and long-term studies, is essential to refine treatment algorithms and improve patient outcomes. By integrating new pharmacologic and nonpharmacologic options, CKD-aP management is shifting toward a more tailored and effective approach that addresses the individual needs of each patient.

Keywords: chronic kidney disease; pruritus; uremic patient; uremic pruritus.

Figure 1

A study investigated the long-term efficacy of an emollient containing glycerol and paraffin for moderate-to-severe uremic xerosis [7]. (Figure created in https://BioRender.com).

Figure 2

A cross-sectional study explored the relationship between skin barrier function, hydration, and pruritus in CKD patients undergoing hemodialysis [8]. ↑, Increase; ↓, decrease. (Figure created in https://BioRender.com).

Figure 3

The study that assessed the efficacy of NB-UVB therapy in CKD-aP [20]. (Figure created in https://BioRender.com).

Figure 4

Assessment of risk of cutaneous cancer in patients receiving phototherapy for pruritus treatment [21] (Figure created in https://BioRender.com).

Figure 5

Ascending and descending pathways for both pain and pruritus [27] (Figure created in https://BioRender.com).

Figure 6

Opioid receptor stimulation producing different effects depending on the synaptic location [4,27] (Figure created in https://BioRender.com).

Figure 7

Peripheral effects of stimulation of specific opioid receptors [4,27] (Figure created in https://BioRender.com).

Figure 8

The efficacy and safety of difelikefalin treatment for uremic pruritus according to a meta-analysis and systematic review [31]. (Figure created in https://BioRender.com).

Figure 9

Nalfurafine, a kappa-opioid receptor (KOR) agonist—potential option for treatment of resistant uremic pruritus; graphic depicts positive effects, adverse events, and dosing according to studies [32,33,34,35,36]. (Figure created in https://BioRender.com).

Figure 10

Efficacy of Pregabalin vs. Gabapentin in Alleviating Pruritus [39]. (Figure created in https://BioRender.com).