If you are a person undergoing treatment for kidney disease, especially Chronic Kidney Disease (CKD), do you sometimes feel like you are itching all over your body unbearably? Sometimes this itching is so severe that you can't even sleep at night. In fact, sometimes there are cases where the skin is injured by scratching. This is a somewhat annoying but common condition seen among kidney patients. Today we are talking about this condition, which is medically known as 'Uremic Pruritus'.
What is Uremic Pruritus?
Simply put, this is a condition of severe itching that occurs in people with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). The specialty of this is that there is usually no obvious rash or skin disease that causes this itching. That is, the body is scratched without any visible skin problem.
This itch can affect you in different ways:
- Sometimes it can come and go after a while.
- Some people may have this itching all day long.
- This itching increases, especially at night, and can disrupt sleep.
- It can feel like it's itching all over your body at once, or it can only be felt in specific areas, such as your back, face, or limbs.
- This itching may become worse when your skin is dry.
- This constant itching can have a major impact on your mental health and quality of life.
Although the term "Uremic" is used to describe this condition, it is not 100% certain that it is caused by the accumulation of toxins in the blood (Uremia). Therefore, it is also called Chronic Kidney Disease-associated Pruritus (CKD-aP).
Who is most likely to see this situation?
This itching is more common among patients undergoing kidney dialysis. That is, people who undergo hemodialysis or peritoneal dialysis are more likely to experience this condition than kidney patients who do not.
Research shows that kidney patients over the age of 70 are more likely to develop this rash and it can be more severe.
Consider this: 70% of people on hemodialysis, or about seven out of ten, experience some level of itching. This is compared to about 25% of chronic kidney disease patients who are not on hemodialysis, or about one in four.
Where on your body do you itch the most?
Many people experience this itching all over their body or over large areas of their body. However, the most common areas that patients report itching the most are the back, face, and the arm that has a dialysis shunt .
How does the doctor diagnose this and what are the reasons?
If you have chronic kidney disease and you have this type of itching, your doctor will first check for other causes. They will check for other changes in the skin, such as a rash. They may also do some blood tests. If no other cause can be found, your doctor will diagnose the condition as Uremic Pruritus.
Experts are still not exactly sure why this happens, but there are a few things they think may contribute to it.
| Possible Cause | Simply put... |
|---|---|
| Accumulation of toxins in the blood (Uremic toxins) | When the kidneys are not working properly, harmful toxins accumulate in the blood. These toxins can stimulate the nerves in the skin and cause itching. |
| Immune system imbalance | Kidney disease can change the way our immune system works. Some of these changes and increased inflammation in the body can cause itching. |
| Neuropathy | Neuropathy can be caused by other chemical imbalances in the body. This is when the nerves don't send or receive signals correctly. These incorrect signals can be interpreted by the brain as an 'itch'. |
| Medications you are taking | Some medications taken for kidney disease can also cause itching as a side effect. |
What are the treatments for this itching?
There is no single treatment that works for everyone. However, your doctor can help you choose a treatment that is right for you. Here are some of the treatments that are currently available.
| Treatment method | Description |
|---|---|
| Changes in hemodialysis | Your doctor can make some changes to your dialysis regimen to help reduce itching. |
| Light therapy (Phototherapy) | This is a treatment that uses light to treat skin conditions. Some types of light therapy have been shown to be effective in reducing itching. |
| Medications for nerve pain | Some medications that are prescribed to relieve nerve pain can also help control itching. For example, drugs called Gabapentin and Pregabalin. |
| Kappa-opioid agonists drugs | These medications work by reducing the nerve signals that cause itching. Diphenhydramine and Nalbuphine are examples of this type of medication. |
| Kidney transplant | This is not a cure for itching. However, research shows that after a kidney transplant, itching is completely gone in about 75% of patients. |
What can I do at home for this itching?
Talk to your doctor about safe ways to control itching at home. You may find some relief from these things:
- Applying a moisturizer to the skin. It is best to apply it after bathing while the skin is still damp.
- Using some anti-itch lotions. But ask your doctor before using anything.
- Many people take antihistamines when they get an itch. But experts say that these medications are not very effective in this condition of uremic pruritus. And they can cause unwanted side effects.
What are the risks if left untreated?
This constant itching can affect both your physical and mental health.
- Constant scratching can damage the skin and lead to infections.
- Lack of sleep can reduce your quality of life.
- In fact, some studies have shown that the mortality rate of kidney patients with this itch is slightly higher than that of patients without itch. It is thought that a major reason for this may be complications caused by sleep deprivation.
So don't dismiss it as "just an itch." It affects your overall health.
Is there a way to prevent this?
There is no specific way to prevent the itching associated with kidney disease. However, if you can identify some of the things (triggers) that make it worse, you can control the itching by avoiding them. For example:
- See if things like dry skin, extreme heat or cold, or stress increase the itching.
- Avoid taking long baths.
- Apply moisturizer immediately after bathing.
- If the weather is dry, use a humidifier in the room.
If you have any itching, tell your doctor how bad it is. Don't just ignore it. Your doctor may be able to help you manage it by making changes to your treatment or using other methods.
Take-Home Message
- Itching is very common among people with chronic kidney disease (CKD) and end-stage renal disease (ESKD).
- This itching is not caused by a visible rash or other skin condition, so don't ignore it as "just an itch."
- No matter how minor your itching is, be sure to tell your doctor about it and explain how it's affecting your life.
- There are various treatments to control this itching, so you don't have to suffer with it.
- Because persistent itching can affect sleep, mental health, and overall life, it is important to seek medical advice as soon as possible.
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