Kidney Week Educational Symposia-Causes and Treatments for CKD-Associated Pruritus

Video Transcription

Video Summary

Kidney Week 2020 hosted a symposium on causes and treatment of CKD-associated pruritus (CKD-aP), an itching syndrome directly related to kidney disease that remains common, variably presenting, and frequently undertreated. Prevalence has historically ranged widely (20–90%) but recent large DOPPS data suggest improvement over time, with patients “very much/extremely” bothered declining from 28% (1996) to 18% (2015). CKD-aP significantly worsens quality of life, sleep, mood, social functioning, and is associated with depression and increased mortality.<br /><br />Dr. Sarah Combs reviewed mechanisms of itch and emphasized that mineral bone disease abnormalities and histamine are not considered primary drivers; antihistamines often fail and mainly sedate. Leading contemporary hypotheses include systemic inflammation (e.g., links with CRP/low albumin), neuropathic alterations in sensory pathways (itch described as burning/tingling; overlap with neuropathic pain; response to gabapentinoids), and opioid receptor imbalance. Mu-opioid agonism can provoke itch, while kappa-opioid agonism can suppress it.<br /><br />Peter Jergensen covered evaluation and management: CKD-aP is a diagnosis of exclusion requiring careful history, skin exam, and use of validated scales (VAS, 5D itch, Skindex, KDQOL). Treatment includes skin care for xerosis, cautious use of gabapentin/pregabalin (noting risks of altered mental status and falls), and emerging kappa-opioid therapies. Difelikefalin, a peripherally selective kappa agonist given post-hemodialysis, showed significant itch and quality-of-life improvements in randomized trials, with more diarrhea/dizziness/nausea.

Asset Subtitle

Divya Monga, Sara Combs, Peter Juergensen
Support is provided by an educational grant from Cara Therapeutics, Inc.

Keywords

CKD-associated pruritus

chronic kidney disease itching

hemodialysis patients

systemic inflammation CRP albumin

neuropathic itch gabapentin pregabalin

opioid receptor imbalance mu kappa

difelikefalin kappa-opioid agonist

itch assessment scales VAS 5D Skindex KDQOL