Kidney Week Educational Symposia-Update on the Epidemiology, Pathogenesis, and Treatment of CKD-Associated Pruritus

Video Transcription

Video Summary

Dr. Hugh Rayner opens a symposium on CKD-associated pruritus (“kidney itch”), highlighting it as a major patient priority and a potentially devastating symptom that can lead to bleeding, scarring, insomnia, psychological distress, depression, impaired quality of life, longer post-dialysis recovery, increased dialysis withdrawal, and higher mortality. A patient testimonial describes intense, deep itch, compulsive scratching, disrupted sleep and relationships, dietary restriction, low energy, and depression.<br /><br />Epidemiology and assessment data from the international DOPPS program show kidney itch is common: typically 35–40% of hemodialysis patients are moderately-to-extremely bothered, with similar prevalence in peritoneal dialysis and improvement after transplant. Many clinicians underestimate its frequency, and many patients do not report itch unless asked. Simple tools (including a single KDQOL question, numerical rating scales, VAS, 5D itch, and body maps) can reliably assess severity and track distribution over time.<br /><br />Pathogenesis evidence suggests itch is largely related to uremia and neuronal/non-histaminergic pathways; mineral bone markers and dialysis clearance (beyond avoiding severe inadequacy) explain little.<br /><br />Treatment guidance emphasizes: ask routinely, gauge severity, use emollients first for mild/moderate itch, and start systemic therapy promptly for severe itch. Antihistamines are not evidence-based. Gabapentin/pregabalin are effective but require low, slow titration to avoid neurotoxicity and falls. Difelikefalin (kappa-opioid agonist) has RCT support as an additional option.

Asset Subtitle

Moderators: Hugh Rayner

Speakers:

Introduction - Hugh Rayner
Who's Itchy and Why? Insights Into the Epidemiology and Pathogenesis of CKD-aP - Ronald Pisoni
Updates on Treatment Options for CKD-aP - Claudio Rigatto

Meta Tag

Date 11/6/2021

Pathway 1 Chronic Kidney Disease

Session ID 408692

Session Type ES - Educational Symposium

Keywords

CKD-associated pruritus

uremic pruritus

hemodialysis patients

DOPPS epidemiology

itch severity assessment tools

KDQOL itch question

non-histaminergic neuronal pathways

gabapentin pregabalin titration

difelikefalin kappa-opioid agonist