Uremic Pruritus

What is uremic pruritus?

Uremic pruritus is itching experienced by people with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). There’s no skin rash that causes the itching and it’s often not specific to any part of your body.

The itching can:

• Come and go.
• Last throughout the day.
• Keep you up at night.
• Feel like it’s all over your body or affect specific body parts.
• Get worse when your skin is dry.
• Affect your mental health and quality of life.

Despite the name, it’s not clear whether you have to have uremia (a buildup of toxins in your blood) to experience this kind of itching. Uremic pruritus is also called chronic kidney disease-associated pruritus (CKD-aP) or end-stage renal disease-associated chronic itch (ESRDCI).

Who experiences uremic pruritus?

People on dialysis (hemodialysis or peritoneal dialysis) are more likely to experience uremic pruritus than those not on dialysis. Studies on additional risk factors have conflicting results. Some show that people older than 70 are more likely to have uremic pruritus and are more likely to have severe itching.

How common is uremic pruritus?

Up to 70% of people who receive hemodialysis experience some degree of itching. Around 25% of people with chronic kidney disease who aren’t on dialysis also have uremic pruritus.

Where do you itch when you have kidney disease?

Many people with uremic pruritus itch all over or on large areas of their body. Your back, face and shunt arm (where you receive dialysis) are the most common specific places you might itch.

How is uremic pruritus diagnosed?

If you have CKD or ESKD and are experiencing itching, your provider will first look for other causes. They’ll check your skin for a rash or other changes. They might order blood tests. They’ll diagnose you with uremic pruritus if they rule out other causes.

What causes uremic pruritus?

Experts aren’t sure why people with CKD and ESKD experience itching. Things that might contribute include:

• Uremic toxins. When your kidneys aren’t working properly, harmful substances can build up (uremia). These toxins might play a role in making you itch.
• Immune system imbalance. CKD can change how well your immune system works. Imbalances and increased inflammation might trigger itching.
• Neuropathy. Other chemical imbalances in your body can lead to neuropathy, a condition where your nerves aren’t sending or receiving signals correctly. Your body might interpret this as itching.
• Medications. People with CKD or ESKD may take medications that contribute to itching.

How do you treat uremia itching?

There’s no single treatment for uremic pruritus that works for everyone. Some available treatments include:

• Dialysis adjustments. Your provider may be able to modify your dialysis treatment to help relieve itching.
• Phototherapy. This is a form of therapy that uses light to treat skin conditions. Some types of phototherapy have been shown effective at reducing uremic pruritus.
• Medications for nerve pain. Certain medications that providers use to calm nerve pain help some people with itching. These include gabapentin and pregabalin.
• Kappa-opioid agonists. These medications relieve itching by reducing the signals to your nerves that make you itch. They include difelikefalin and nalbuphine.
• Kidney transplant. While not a treatment specifically for uremic pruritus, some people with CKD receive a kidney transplant. In one study, itching went away completely in nearly 3 out of 4 people who received a transplant.

Scientists are studying other treatments for uremic pruritus to test their effectiveness.

What can I do at home to treat uremic pruritus?

Talk to your provider about what you can do to safely treat itching at home. You might find keeping your skin moisturized or using anti-itch lotions gives you some relief. Experts don’t usually recommend using antihistamines (like allergy medicines) in most cases. These don’t seem to work very well for uremic pruritus and can cause side effects.

What are the possible complications or risks of not treating uremic pruritus?

Constant itching can affect both your physical and mental health. Scratching can damage your skin and lead to infection. Persistent itching can keep you from sleeping and affect your quality of life. In fact, some studies suggest that people with uremic pruritus have a higher mortality (death) rate than those with CKD or ESKD who don’t have it. Experts think a lack of quality sleep could contribute to the increased rate.

Can CKD itching be prevented?

There are no specific steps you can take to prevent itching associated with kidney disease. But if you find certain things make it worse — like dryness, temperature or stress — you might be able to avoid flare-ups. Depending on your triggers, some strategies might include:

• Taking shorter showers.
• Applying moisturizer to your skin right after a shower or bath.
• Avoiding extreme temperature changes.
• Using a humidifier in drier months.

When should this symptom be treated by a doctor or healthcare provider?

Let your healthcare provider know if you’re experiencing itching and how severe it is. There might be changes to your treatment they can make or other ways to manage it so it doesn’t impact your quality of life.

A note from Cleveland Clinic

Itching can be mildly bothersome or completely debilitating. If you have chronic or end-stage kidney disease and itching is affecting your life, talk to your healthcare provider. Make sure they know its impact on you. They can work with you to come up with treatments to get you relief.