Chronic Kidney Diseases

Uraemic pruritus or CKD-associated pruritus (CKD-aP) is a frequent and often very tormenting symptom in patients with advanced or end stage renal disease, severely compromising the quality of life of patients affected. 25 to more than 50 % of patients on hemodialysis are reported to suffer from CKD-aP. The pathogenesis of CKD-aP is still obscure. Besides parathyroid hormone, histamine and calcium-phosphate skin-depositions have been suspected to play a role. More recently derangements in the opioid system and an inflammatory condition have been suspected to be involved in the pathogenesis of CKD-aN, but remain unproven. Symptom control is often hard to achieve. Besides gabapentin and pregabalin, treatment with nalfurafine may be promising. In many cases UVB-phototherapy is effective in reducing intensity of itch. Topical anti-inflammatory treatment with gamma linolenic acid or tacrolimus might be used in refractory cases. Due to the lack of licensed compounds a stepwise therapeutic approach strongly respecting a good risk-benefit relation should be adopted. In very severe and refractory cases patients suitable for renal transplantation might be switched to “high urgency” status, as successful renal transplantation cures CKD-aP in almost all cases.