Kidney Week Educational Symposia-Recognizing and Managing the Itch of CKD-Associated Pruritus: Scratching the Surface

Video Transcription

Video Summary

This symposium reviewed chronic kidney disease–associated pruritus (CKD-aP), emphasizing that itch is common, burdensome, and often overlooked. Data from large international cohorts (notably DOPPS) show that roughly 40% of hemodialysis patients report moderate-to-severe itching, yet many patients do not report symptoms and most medical directors underestimate prevalence. CKD-aP is linked to poor sleep, depression, reduced quality of life, and higher mortality. It also occurs in non–dialysis-dependent CKD (about one-quarter with moderate-to-severe symptoms).<br /><br />Pathogenesis remains incompletely understood. Current evidence does not support a major role for histamine or mineral bone parameters (phosphorus, PTH) as primary drivers, and antihistamines are generally ineffective aside from sedation. Leading hypotheses include systemic inflammation, neuropathic changes, and opioid receptor imbalance (mu/kappa).<br /><br />Diagnosis is clinical and by exclusion, requiring evaluation for dermatologic disease, systemic causes, and infestations (e.g., scabies/bedbugs). Presentation is typically bilateral, symmetric, generalized itch with excoriations or prurigo nodularis.<br /><br />Management is stepwise: optimize skin care with emollients; consider UVB phototherapy; ensure adequate dialysis (avoid underdialysis, consider higher Kt/V); use gabapentinoids cautiously due to falls/mental status risk; and for moderate-to-severe cases, consider peripherally acting kappa-opioid agonists (e.g., difelikefalin), which improved itch scores in major trials but may cause GI symptoms, dizziness, and falls and is avoided in significant liver disease.

Asset Subtitle

Moderators: Denise Link

Introduction - Denise Link
Pathogenesis and Diagnosis of CKD-Associated Pruritus - Sara Combs
Optimal Treatment and Management Strategies for CKD-Associated Pruritus - David Steele

Support is provided by an educational grant from CSL Vifor.

Meta Tag

Date 11/5/2022

Pathway 1 CKD Non-Dialysis

Pathway 2 Dialysis

Session ID 438062

Session Type ES - Educational Symposium

Keywords

chronic kidney disease-associated pruritus

CKD-aP

hemodialysis itching prevalence

DOPPS cohort data

sleep disturbance and quality of life

opioid receptor imbalance mu kappa

difelikefalin kappa-opioid agonist

stepwise management emollients UVB gabapentinoids