Top

Published in:

12-05-2023 | Opioids | Review

Chronic kidney disease–associated pruritus: what is known and its application in children

Authors: Shweta Shah, Elizabeth Onugha, Sarah J. Swartz

Published in: Pediatric Nephrology | Issue 1/2024

Abstract

Chronic kidney disease–associated pruritus (CKD-aP) or uremic pruritus (UP) is a frequent symptom in patients with kidney failure receiving kidney replacement therapy. Severe chronic kidney disease–associated pruritus correlates with poor outcome in patients on dialysis. It is multifactorial in etiology and has a significant impact on quality of life. There is, however, limited data for children. This review summarizes current epidemiology, clinical characteristics, pruritus scoring systems, and available therapeutic options for pruritus in patients with chronic kidney disease and those receiving dialysis. Optimal care requires proper awareness of the severity of symptoms, the impact on quality of life, and the possible long-term outcomes. Optimizing dialysis prescription and correcting electrolyte abnormalities are important treatment targets. A wide range of therapeutic options is also available although none are well-studied in children. An earlier recognition of this debilitating symptom in children and treatment is imperative.

Graphical Abstract

Available only for authorised users

Agarwal P, Garg V, Karagaiah P, Szepietowski JC, Grabbe S, Goldust M (2021) Chronic kidney disease-associated pruritus. Toxins (Basel) 13:527. https://doi.org/10.3390/toxins13080527CrossRefPubMed

Pisoni RL, Wikstrom B, Elder SJ, Akizawa T, Asano Y, Keen ML, Saran R, Mendelssohn DC, Young EW, Port FK (2006) Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 21:3495–3505. https://doi.org/10.1093/ndt/gfl461CrossRefPubMed

Rayner HC, Larkina M, Wang M, Graham-Brown M, van der Veer SN, Ecder T, Hasegawa T, Kleophas W, Bieber BA, Tentori F, Robinson BM, Pisoni RL (2017) International comparisons of prevalence, awareness, and treatment of pruritus in people on hemodialysis. Clin J Am Soc Nephrol 12:2000–2007. https://doi.org/10.2215/CJN.03280317CrossRefPubMedPubMedCentral

Shirazian S, Aina O, Park Y, Chowdhury N, Leger K, Hou L, Miyawaki N, Mathur VS (2017) Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges. Int J Nephrol Renovasc Dis 10:11–26. https://doi.org/10.2147/IJNRD.S108045CrossRefPubMedPubMedCentral

Mettang T, Pauli-Magnus C, Alscher DM (2002) Uraemic pruritus–new perspectives and insights from recent trials. Nephrol Dial Transplant 17:1558–1563. https://doi.org/10.1093/ndt/17.9.1558CrossRefPubMed

Wojtowicz-Prus E, Kilis-Pstrusinska K, Reich A, Zachwieja K, Miklaszewska M, Szczepanska M, Szepietowski JC (2016) Chronic kidney disease-associated pruritus in children. Acta Derm Venereol 96:938–942. https://doi.org/10.2340/00015555-2454CrossRefPubMed

Senturk N, Ozkaya O, Aytekin S, Bek K, Acikgoz Y, Aydin F, Bek Y, Turanli AY (2008) Characteristics of pruritus in children on peritoneal dialysis. Nephron Clin Pract 109:c168-172. https://doi.org/10.1159/000145461CrossRefPubMed

Wu HY, Peng YS, Chen HY, Tsai WC, Yang JY, Hsu SP, Pai MF, Lu HM, Chiang JF, Ko MJ, Wen SY, Chiu HC (2016) A comparison of uremic pruritus in patients receiving peritoneal dialysis and hemodialysis. Medicine (Baltimore) 95:e2935. https://doi.org/10.1097/MD.0000000000002935CrossRefPubMed

Min JW, Kim SH, Kim YO, Jin DC, Song HC, Choi EJ, Kim YL, Kim YS, Kang SW, Kim NH, Yang CW, Kim YK (2016) Comparison of uremic pruritus between patients undergoing hemodialysis and peritoneal dialysis. Kidney Res Clin Pract 35:107–113. https://doi.org/10.1016/j.krcp.2016.02.002CrossRefPubMedPubMedCentral

10.

Schricker S, Weisshaar E, Kupfer J, Mettang T (2020) Prevalence of pruritus in a single cohort of long-term kidney transplant recipients. Acta Derm Venereol 100:adv00066. https://doi.org/10.2340/00015555-3421CrossRefPubMed

11.

Chen ZJ, Cao G, Tang WX, Lv XY, Huang SM, Qin W, Ping F, Ye T (2009) A randomized controlled trial of high-permeability haemodialysis against conventional haemodialysis in the treatment of uraemic pruritus. Clin Exp Dermatol 34:679–683. https://doi.org/10.1111/j.1365-2230.2008.03075.xCrossRefPubMed

12.

Ko MJ, Wu HY, Chen HY, Chiu YL, Hsu SP, Pai MF, Ju Y, Lai CF, Lu HM, Huang SC, Yang SY, Wen SY, Chiu HC, Hu FC, Peng YS, Jee SH (2013) Uremic pruritus, dialysis adequacy, and metabolic profiles in hemodialysis patients: a prospective 5-year cohort study. PLoS One 8:e71404. https://doi.org/10.1371/journal.pone.0071404CrossRefPubMedPubMedCentral

13.

Weisshaar E, Weiss M, Passlick-Deetjen J, Tschulena U, Maleki K, Mettang T (2015) Laboratory and dialysis characteristics in hemodialysis patients suffering from chronic itch–results from a representative cross-sectional study. BMC Nephrol 16:184. https://doi.org/10.1186/s12882-015-0177-3CrossRefPubMedPubMedCentral

14.

Narita I, Alchi B, Omori K, Sato F, Ajiro J, Saga D, Kondo D, Skatsume M, Maruyama S, Kazama JJ, Akazawa K, Gejyo F (2006) Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney Int 69:1626–1632. https://doi.org/10.1038/sj.ki.5000251CrossRefPubMed

15.

Shirazian S, Kline M, Sakhiya V, Schanler M, Moledina D, Patel C, Hazzan A, Fishbane S (2013) Longitudinal predictors of uremic pruritus. J Ren Nutr 23:428–431. https://doi.org/10.1053/j.jrn.2013.08.002CrossRefPubMed

16.

Duque MI, Thevarajah S, Chan YH, Tuttle AB, Freedman BI, Yosipovitch G (2006) Uremic pruritus is associated with higher kt/V and serum calcium concentration. Clin Nephrol 66:184–191. https://doi.org/10.5414/cnp66184CrossRefPubMed

17.

Hampers CL, Katz AI, Wilson RE, Merrill JP (1968) Disappearance of “uremic” itching after subtotal parathyroidectomy. N Engl J Med 279:695–697. https://doi.org/10.1056/NEJM196809262791307CrossRefPubMed

18.

Chou FF, Ho JC, Huang SC, Sheen-Chen SM (2000) A study on pruritus after parathyroidectomy for secondary hyperparathyroidism. J Am Coll Surg 190:65–70. https://doi.org/10.1016/s1072-7515(99)00212-4CrossRefPubMed

19.

Cho YL, Liu HN, Huang TP, Tarng DC (1997) Uremic pruritus: roles of parathyroid hormone and substance P. J Am Acad Dermatol 36:538–543. https://doi.org/10.1016/s0190-9622(97)70240-8CrossRefPubMed

20.

Dashti-Khavidaki S, Khalili H, Vahedi SM, Lessan-Pezeshki M (2010) Serum zinc concentrations in patients on maintenance hemodialysis and its relationship with anemia, parathyroid hormone concentrations and pruritus severity. Saudi J Kidney Dis Transpl 21:641–645PubMed

21.

Kimmel M, Alscher DM, Dunst R, Braun N, Machleidt C, Kiefer T, Stulten C, van der Kuip H, Pauli-Magnus C, Raub U, Kuhlmann U, Mettang T (2006) The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients. Nephrol Dial Transplant 21:749–755. https://doi.org/10.1093/ndt/gfi204CrossRefPubMed

22.

Zhao JH, Zhu QS, Li YW, Wang LL (2021) Determinants of the intensity of uremic pruritus in patients receiving maintenance hemodialysis: a cross-sectional study. PLoS One 16:e0245370. https://doi.org/10.1371/journal.pone.0245370CrossRefPubMedPubMedCentral

23.

Fallahzadeh MK, Roozbeh J, Geramizadeh B, Namazi MR (2011) Interleukin-2 serum levels are elevated in patients with uremic pruritus: a novel finding with practical implications. Nephrol Dial Transplant 26:3338–3344. https://doi.org/10.1093/ndt/gfr053CrossRefPubMed

24.

Creagan ET, Rowland KM Jr, Suman VJ, Kardinal CG, Marschke RF Jr, Marks RS, Maples WJ (1997) Phase II study of combined levamisole with recombinant interleukin-2 in patients with advanced malignant melanoma. Am J Clin Oncol 20:490–492. https://doi.org/10.1097/00000421-199710000-00011CrossRefPubMed

25.

Morton CA, Lafferty M, Hau C, Henderson I, Jones M, Lowe JG (1996) Pruritus and skin hydration during dialysis. Nephrol Dial Transplant 11:2031–2036. https://doi.org/10.1093/oxfordjournals.ndt.a027092CrossRefPubMed

26.

Wojtowicz-Prus E, Kilis-Pstrusinska K, Reich A, Zachwieja K, Miklaszewska M, Szczepanska M, Szepietowski JC (2015) Disturbed skin barrier in children with chronic kidney disease. Pediatr Nephrol 30:333–338. https://doi.org/10.1007/s00467-014-2932-2CrossRefPubMed

27.

Szepietowski JC, Reich A, Schwartz RA (2004) Uraemic xerosis. Nephrol Dial Transplant 19:2709–2712. https://doi.org/10.1093/ndt/gfh480CrossRefPubMed

28.

Kato A, Hamada M, Maruyama T, Maruyama Y, Hishida A (2000) Pruritus and hydration state of stratum corneum in hemodialysis patients. Am J Nephrol 20:437–442. https://doi.org/10.1159/000046196CrossRefPubMed

29.

Yoshida Y, Hirama A, Hashimoto K, Sato T, Yokota N, Saeki H, Kishida M, Nakamura H, Kanakubo A, Tsuruoka S (2021) Efficacy of a moisturizer for pruritus accompanied by xerosis in patients undergoing dialysis: a multicenter, open-label, randomized verification study. J Dermatol 48:1327–1335. https://doi.org/10.1111/1346-8138.15950CrossRefPubMedPubMedCentral

30.

Shimizu Y, Sonoda A, Nogi C, Ogushi Y, Kanda R, Yamaguchi S, Nohara N, Aoki T, Yamada K, Nakata J, Io H, Kurusu A, Hamada C, Horikoshi S, Tomino Y (2014) B-type (brain) natriuretic peptide and pruritus in hemodialysis patients. Int J Nephrol Renovasc Dis 7:329–335. https://doi.org/10.2147/IJNRD.S65929CrossRefPubMedPubMedCentral

31.

Papoiu AD, Emerson NM, Patel TS, Kraft RA, Valdes-Rodriguez R, Nattkemper LA, Coghill RC, Yosipovitch G (2014) Voxel-based morphometry and arterial spin labeling fMRI reveal neuropathic and neuroplastic features of brain processing of itch in end-stage renal disease. J Neurophysiol 112:1729–1738. https://doi.org/10.1152/jn.00827.2013CrossRefPubMedPubMedCentral

32.

Zakrzewska-Pniewska B, Jedras M (2001) Is pruritus in chronic uremic patients related to peripheral somatic and autonomic neuropathy? Study by R-R interval variation test (RRIV) and by sympathetic skin response (SSR). Neurophysiol Clin 31:181–193. https://doi.org/10.1016/s0987-7053(01)00257-xCrossRefPubMed

33.

Mettang T, Fritz P, Weber J, Machleidt C, Hubel E, Kuhlmann U (1990) Uremic pruritus in patients on hemodialysis or continuous ambulatory peritoneal dialysis (CAPD). The role of plasma histamine and skin mast cells. Clin Nephrol 34:136–141PubMed

34.

Kim BS, Inan S, Stander S, Sciascia T, Szepietowski JC, Yosipovitch G (2022) Role of kappa-opioid and mu-opioid receptors in pruritus: peripheral and central itch circuits. Exp Dermatol 31:1900–1907. https://doi.org/10.1111/exd.14669CrossRefPubMedPubMedCentral

35.

Wieczorek A, Krajewski P, Koziol-Galczynska M, Szepietowski JC (2020) Opioid receptors expression in the skin of haemodialysis patients suffering from uraemic pruritus. J Eur Acad Dermatol Venereol 34:2368–2372. https://doi.org/10.1111/jdv.16360CrossRefPubMed

36.

Barke KE, Hough LB (1993) Opiates, mast cells and histamine release. Life Sci 53:1391–1399. https://doi.org/10.1016/0024-3205(93)90581-mCrossRefPubMed

37.

Schricker S, Kimmel M (2021) Unravelling the pathophysiology of chronic kidney disease-associated pruritus. Clin Kidney J 14(Suppl 3):i23–i31. https://doi.org/10.1093/ckj/sfab200CrossRefPubMedPubMedCentral

38.

Matsumoto M, Ichimaru K, Horie A (1985) Pruritus and mast cell proliferation of the skin in end stage renal failure. Clin Nephrol 23:285–288PubMed

39.

Dugas-Breit S, Schopf P, Dugas M, Schiffl H, Rueff F, Przybilla B (2005) Baseline serum levels of mast cell tryptase are raised in hemodialysis patients and associated with severity of pruritus. J Dtsch Dermatol Ges 3:343–347. https://doi.org/10.1111/j.1610-0387.2005.05706.xCrossRefPubMed

40.

Francos GC, Kauh YC, Gittlen SD, Schulman ES, Besarab A, Goyal S, Burke JF Jr (1991) Elevated plasma histamine in chronic uremia. Effects of ketotifen on pruritus. Int J Dermatol 30:884–889. https://doi.org/10.1111/j.1365-4362.1991.tb04360.xCrossRefPubMed

41.

Moon SJ, Kim HJ, Cho SB, Lee SH, Choi HY, Park HC, Ha SK (2014) Epidermal proteinase-activated receptor-2 expression is increased in end-stage renal disease patients with pruritus: a pilot study. Electrolyte Blood Press 12:74–79. https://doi.org/10.5049/EBP.2014.12.2.74CrossRefPubMedPubMedCentral

42.

Huang WH, Lin JH, Weng CH, Hsu CW, Yen TH (2016) Environmental NO2 and CO exposure: ignored factors associated with uremic pruritus in patients undergoing hemodialysis. Sci Rep 6:31168. https://doi.org/10.1038/srep31168CrossRefPubMedPubMedCentral

43.

Mathur VS, Lindberg J, Germain M, Block G, Tumlin J, Smith M, Grewal M, McGuire D, National Registry Investigators ITCH (2010) A longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol 5:1410–1419. https://doi.org/10.2215/CJN.00100110CrossRefPubMedPubMedCentral

44.

Silverberg NB, Singh A, Laude TA (2001) Cutaneous manifestations of chronic renal failure in children of color. Pediatr Dermatol 18:199–204. https://doi.org/10.1046/j.1525-1470.2001.018003199.xCrossRefPubMed

45.

Attia EA, Hassan SI, Youssef NM (2010) Cutaneous disorders in uremic patients on hemodialysis: an Egyptian case-controlled study. Int J Dermatol 49:1024–1030. https://doi.org/10.1111/j.1365-4632.2010.04466.xCrossRefPubMed

46.

Ramakrishnan K, Bond TC, Claxton A, Sood VC, Kootsikas M, Agnese W, Sibbel S (2013) Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms. Int J Nephrol Renovasc Dis 7:1–12. https://doi.org/10.2147/IJNRD.S52985CrossRefPubMedPubMedCentral

47.

Keithi-Reddy SR, Patel TV, Armstrong AW, Singh AK (2007) Uremic pruritus. Kidney Int 72:373–377. https://doi.org/10.1038/sj.ki.5002197CrossRefPubMed

48.

Caffarelli C, Paravati F, El Hachem M, Duse M, Bergamini M, Simeone G, Barbagallo M, Bernardini R, Bottau P, Bugliaro F, Caimmi S, Chiera F, Crisafulli G, De Ranieri C, Di Mauro D, Diociaiuti A, Franceschini F, Gola M, Licari A, Liotti L, Mastrorilli C, Minasi D, Mori F, Neri I, Pantaleo A, Saretta F, Tesi CF, Corsello G, Marseglia GL, Villani A, Cardinale F (2019) Management of chronic urticaria in children: a clinical guideline. Ital J Pediatr 45:101. https://doi.org/10.1186/s13052-019-0695-xCrossRefPubMedPubMedCentral

49.

Nowak DA, Yeung J (2017) Diagnosis and treatment of pruritus. Can Fam Physician 63:918–924PubMedPubMedCentral

50.

Reich A, Chatzigeorkidis E, Zeidler C, Osada N, Furue M, Takamori K, Ebata T, Augustin M, Szepietowski JC, Stander S (2017) Tailoring the cut-off values of the visual analogue scale and numeric rating scale in itch assessment. Acta Derm Venereol 97:759–760. https://doi.org/10.2340/00015555-2642CrossRefPubMed

51.

Evans JM, Glazer A, Lum R, Heale E, MacKinnon M, Blake PG, Walsh M (2020) Implementing a patient-reported outcome measure for hemodialysis patients in routine clinical care: perspectives of patients and providers on ESAS-r:Renal. Clin J Am Soc Nephrol 15:1299–1309. https://doi.org/10.2215/CJN.01840220CrossRefPubMedPubMedCentral

52.

Greenham L, Bennett PN, Dansie K, Viecelli AK, Jesudason S, Mister R, Smyth B, Westall P, Herzog S, Brown C, Handke W, Palmer SC, Caskey FJ, Couchoud C, Simes J, McDonald SP, Morton RL (2022) The Symptom Monitoring with Feedback Trial (SWIFT): protocol for a registry-based cluster randomised controlled trial in haemodialysis. Trials 23:419. https://doi.org/10.1186/s13063-022-06355-0CrossRefPubMedPubMedCentral

53.

Altinok Ersoy N, Akyar I (2019) Multidimensional pruritus assessment in hemodialysis patients. BMC Nephrol 20:42. https://doi.org/10.1186/s12882-019-1234-0CrossRefPubMedPubMedCentral

54.

Balaskas E, Szepietowski JC, Bessis D, Ioannides D, Ponticelli C, Ghienne C, Taberly A, Dupuy P (2011) Randomized, double-blind study with glycerol and paraffin in uremic xerosis. Clin J Am Soc Nephrol 6:748–752. https://doi.org/10.2215/CJN.05490610CrossRefPubMedPubMedCentral

55.

Okada K, Matsumoto K (2004) Effect of skin care with an emollient containing a high water content on mild uremic pruritus. Ther Apher Dial 8:419–422. https://doi.org/10.1111/j.1526-0968.2004.00175.xCrossRefPubMed

56.

Makhlough A, Ala S, Haj-Heydari Z, Kashi Z, Bari A (2010) Topical capsaicin therapy for uremic pruritus in patients on hemodialysis. Iran J Kidney Dis 4:137–140PubMed

57.

Young TA, Patel TS, Camacho F, Clark A, Freedman BI, Kaur M, Fountain J, Williams LL, Yosipovitch G, Fleischer AB Jr (2009) A pramoxine-based anti-itch lotion is more effective than a control lotion for the treatment of uremic pruritus in adult hemodialysis patients. J Dermatolog Treat 20:76–81. https://doi.org/10.1080/09546630802441218CrossRefPubMed

58.

Feily A, Dormanesh B, Ghorbani AR, Moosavi Z, Kouchak M, Cheraghian B, Mousavi SS, Mehrabian A, Ranjbari N (2012) Efficacy of topical cromolyn sodium 4% on pruritus in uremic nephrogenic patients: a randomized double-blind study in 60 patients. Int J Clin Pharmacol Ther 50:510–513. https://doi.org/10.5414/cp201629CrossRefPubMed

59.

Aquino TMO, Luchangco KAC, Sanchez EV, Verallo-Rowell VM (2020) A randomized controlled study of 6% gabapentin topical formulation for chronic kidney disease-associated pruritus. Int J Dermatol 59:955–961. https://doi.org/10.1111/ijd.14953CrossRefPubMed

60.

Duque MI, Yosipovitch G, Fleischer AB Jr, Willard J, Freedman BI (2005) Lack of efficacy of tacrolimus ointment 0.1% for treatment of hemodialysis-related pruritus: a randomized, double-blind, vehicle-controlled study. J Am Acad Dermatol 52:519–521. https://doi.org/10.1016/j.jaad.2004.08.050CrossRefPubMed

61.

Rosner MH (2006) Cromolyn sodium: a potential therapy for uremic pruritus? Hemodial Int 10:189–192. https://doi.org/10.1111/j.1542-4758.2006.00093.xCrossRefPubMed

62.

Vessal G, Sagheb MM, Shilian S, Jafari P, Samani SM (2010) Effect of oral cromolyn sodium on CKD-associated pruritus and serum tryptase level: a double-blind placebo-controlled study. Nephrol Dial Transplant 25:1541–1547. https://doi.org/10.1093/ndt/gfp628CrossRefPubMed

63.

Mohammadi Kebar S, Sharghi A, Ghorghani M, Hoseininia S (2020) Comparison of gabapentin and hydroxyzine in the treatment of pruritus in patients on dialysis. Clin Exp Dermatol 45:866–871. https://doi.org/10.1111/ced.14270CrossRefPubMed

64.

Shohrati M, Davoudi SM, Keshavarz S, Sadr B, Tajik A (2007) Cetirizine, doxepine, and hydroxyzine in the treatment of pruritus due to sulfur mustard: a randomized clinical trial. Cutan Ocul Toxicol 26:249–255. https://doi.org/10.1080/15569520701212340CrossRefPubMed

65.

Nakhaee S, Nasiri A, Waghei Y, Morshedi J (2015) Comparison of Avena sativa, vinegar, and hydroxyzine for uremic pruritus of hemodialysis patients: a crossover randomized clinical trial. Iran J Kidney Dis 9:316–322PubMed

66.

Nasrollahi AR, Miladipour A, Ghanei E, Yavari P, Haghverdi F (2007) Montelukast for treatment of refractory pruritus in patients on hemodialysis. Iran J Kidney Dis 1:73–77PubMed

67.

Mahmudpour M, Roozbeh J, Raiss Jalali GA, Pakfetrat M, Ezzat Zadegan S, Sagheb MM (2017) Therapeutic effect of montelukast for treatment of uremic pruritus in hemodialysis patients. Iran J Kidney Dis 11:50–55PubMed

68.

Nofal E, Farag F, Nofal A, Eldesouky F, Alkot R, Abdelkhalik Z (2016) Gabapentin: a promising therapy for uremic pruritus in hemodialysis patients: a randomized-controlled trial and review of literature. J Dermatolog Treat 27:515–519. https://doi.org/10.3109/09546634.2016.1161161CrossRefPubMed

69.

Pour-Reza-Gholi F, Nasrollahi A, Firouzan A, Nasli Esfahani E, Farrokhi F (2007) Low-dose doxepin for treatment of pruritus in patients on hemodialysis. Iran J Kidney Dis 1:34–37PubMed

70.

Foroutan N, Etminan A, Nikvarz N, Shojai Shahrokh Abadi M (2017) Comparison of pregabalin with doxepin in the management of uremic pruritus: a randomized single blind clinical trial. Hemodial Int 21:63–71. https://doi.org/10.1111/hdi.12455CrossRefPubMed

71.

Haber R, Bachour J, Salloum A, Maacaron T, Khoury F, Habr L, Ammoury A, Joubran N (2020) Comparison of gabapentin and doxepin in the management of uremic pruritus: a randomized crossover clinical trial. Dermatol Ther 33:e14522. https://doi.org/10.1111/dth.14522CrossRefPubMed

72.

Gholyaf M, Sheikh V, Yasrebifar F, Mohammadi Y, Mirjalili M, Mehrpooya M (2020) Effect of mirtazapine on pruritus in patients on hemodialysis: a cross-over pilot study. Int Urol Nephrol 52:1155–1165. https://doi.org/10.1007/s11255-020-02473-3CrossRefPubMed

73.

Wikstrom B, Gellert R, Ladefoged SD, Danda Y, Akai M, Ide K, Ogasawara M, Kawashima Y, Ueno K, Mori A, Ueno Y (2005) Kappa-opioid system in uremic pruritus: multicenter, randomized, double-blind, placebo-controlled clinical studies. J Am Soc Nephrol 16:3742–3747. https://doi.org/10.1681/ASN.2005020152CrossRefPubMed

74.

Peer G, Kivity S, Agami O, Fireman E, Silverberg D, Blum M, laina A, (1996) Randomised crossover trial of naltrexone in uraemic pruritus. Lancet 348:1552–1554. https://doi.org/10.1016/s0140-6736(96)04176-1CrossRefPubMed

75.

Fishbane S, Jamal A, Munera C, Wen W, Menzaghi F, KALM-1 Trial Investigators (2020) A phase 3 trial of difelikefalin in hemodialysis patients with pruritus. N Engl J Med 382:222–232. https://doi.org/10.1056/NEJMoa1912770CrossRefPubMed

76.

Lipman ZM, Yosipovitch G (2021) An evaluation of difelikefalin as a treatment option for moderate-to-severe pruritus in end stage renal disease. Expert Opin Pharmacother 22:549–555. https://doi.org/10.1080/14656566.2020.1849142CrossRefPubMed

77.

Weiner DE, Vervloet MG, Walpen S, Schaufler T, Munera C, Menzaghi F, Wen W, Bhaduri S, Germain MJ, Investigators Trial (2022) Safety and effectiveness of difelikefalin in patients with moderate-to-severe pruritus undergoing hemodialysis: an open-label, multicenter study. Kidney Med 4:100542. https://doi.org/10.1016/j.xkme.2022.100542CrossRefPubMedPubMedCentral

78.

Simonsen E, Komenda P, Lerner B, Askin N, Bohm C, Shaw J, Tangri N, Rigatto C (2017) Treatment of uremic pruritus: a systematic review. Am J Kidney Dis 70:638–655. https://doi.org/10.1053/j.ajkd.2017.05.018CrossRefPubMed

79.

Sapam R, Waikhom R (2018) Role of narrow band ultra violet radiation as an add-on therapy in peritoneal dialysis patients with refractory uremic pruritus. World J Nephrol 7:84–89. https://doi.org/10.5527/wjn.v7.i4.84CrossRefPubMedPubMedCentral

80.

Penny JD, Salerno FR, Akbari A, McIntyre CW (2021) Pruritus: is there a grain of salty truth? Hemodial Int 25:E10–E14. https://doi.org/10.1111/hdi.12885CrossRefPubMed

81.

To TH, Clark K, Lam L, Shelby-James T, Currow DC (2012) The role of ondansetron in the management of cholestatic or uremic pruritus–a systematic review. J Pain Symptom Manage 44:725–730. https://doi.org/10.1016/j.jpainsymman.2011.11.007CrossRefPubMed

82.

Mettang T, Krumme B, Bohler J, Roeckel A (2007) Pentoxifylline as treatment for uraemic pruritus–an addition to the weak armentarium for a common clinical symptom? Nephrol Dial Transplant 22:2727–2728. https://doi.org/10.1093/ndt/gfm343CrossRefPubMed

83.

Badiee Aval S, Ravanshad Y, Azarfar A, Mehrad-Majd H, Torabi S, Ravanshad S (2018) A systematic review and meta-analysis of using acupuncture and acupressure for uremic pruritus. Iran J Kidney Dis 12:78–83PubMed

84.

Pakfetrat M, Basiri F, Malekmakan L, Roozbeh J (2014) Effects of turmeric on uremic pruritus in end stage renal disease patients: a double-blind randomized clinical trial. J Nephrol 27:203–207. https://doi.org/10.1007/s40620-014-0039-2CrossRefPubMed

85.

Tseng CY, Wu TT, Lai CW, Lin HJ, Chou CY, Chang CT, Chen HC (2018) Vegetarian diet may ameliorate uremic pruritus in hemodialysis patients. Ren Fail 40:514–519. https://doi.org/10.1080/0886022X.2018.1512871CrossRefPubMedPubMedCentral

86.

Kinugasa E, Igawa K, Shimada H, Kondo M, Funakoshi S, Imada N, Itami N, Fukazawa N, Takubo R, Kawata Y, Murota H (2021) Anti-pruritic effect of nemolizumab in hemodialysis patients with uremic pruritus: a phase II, randomized, double-blind, placebo-controlled clinical study. Clin Exp Nephrol 25:875–884. https://doi.org/10.1007/s10157-021-02047-2CrossRefPubMedPubMedCentral

87.

Hercz D, Jiang SH, Webster AC (2020) Interventions for itch in people with advanced chronic kidney disease. Cochrane Database Syst Rev 12:CD011393. https://doi.org/10.1002/14651858.CD011393.pub2CrossRefPubMed

88.

Sukul N, Speyer E, Tu C, Bieber BA, Li Y, Lopes AA, Asahi K, Mariani L, Laville M, Rayner HC, Stengel B, Robinson BM, Pisoni RL (2019) Pruritus and patient reported outcomes in non-dialysis CKD. Clin J Am Soc Nephrol 14:673–681. https://doi.org/10.2215/CJN.09600818CrossRefPubMedPubMedCentral

89.

Ting SW, Fan PC, Lin YS, Lin MS, Lee CC, Kuo G, Chang CH (2020) Association between uremic pruritus and long-term outcomes in patients undergoing dialysis. J Am Acad Dermatol 83:924–925. https://doi.org/10.1016/j.jaad.2020.01.011CrossRefPubMed

Title: Chronic kidney disease–associated pruritus: what is known and its application in children
Authors: Shweta Shah
Elizabeth Onugha
Sarah J. Swartz
Publication date: 12-05-2023
Publisher: Springer Berlin Heidelberg
Keywords: Opioids
Opioids
Peritoneal Dialysis
Pruritus
Chronic Kidney Disease
Gabapentin
Published in: Pediatric Nephrology / Issue 1/2024
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-023-05998-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Chronic kidney disease–associated pruritus: what is known and its application in children

Abstract

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Graphical Abstract

Please log in to get access to this content

Other articles of this Issue 1/2024

Safety and timeliness of telemedicine initiation of continuous kidney replacement therapy

Efficacy and safety of isotonic versus hypotonic intravenous maintenance fluids in hospitalized children: an updated systematic review and meta-analysis of randomized controlled trials

A lack of KDIGO guidelines for adolescents and young adults with IgA nephropathy

Body mass index and implications for pediatric kidney health: a cross-sectional study with urinary biomarkers

New perspectives in pediatric dialysis technologies: the case for neonates and infants with acute kidney injury

Lipid abnormalities in pediatric kidney transplant recipients on steroid withdrawal maintenance immunosuppression