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Uremic pruritus
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Journal Article
Uremic pruritus
2015
Overview
Uremic pruritus or chronic kidney disease-associated pruritus (CKD-aP) remains a frequent and compromising symptom in patients with advanced or end-stage renal disease, strongly reducing the patient’s quality of life. More than 40% of patients undergoing hemodialysis suffer from chronic pruritus; half of them complain about generalized pruritus. The pathogenesis of CKD-aP remains obscure. Parathormone and histamine as well as calcium and magnesium salts have been suspected as pathogenetic factors. Newer hypotheses are focusing on opioid-receptor derangements and microinflammation as possible causes of CKD-aP, although until now this could not be proven. Pruritus may be extremely difficult to control, as therapeutic options are limited. The most consequential approaches to treatment are: topical treatment with or without anti-inflammatory compounds or systemic treatment with (a) gabapentin, (b) μ-opioid receptor antagonists and κ-agonists, (c) drugs with an anti-inflammatory action, (d) phototherapy, or (e) acupuncture. A stepwise approach is suggested starting with emollients and gabapentin or phototherapy as first-line treatments. In refractory cases, more experimental options as μ-opioid-receptor—antagonists (i.e., naltrexone) or κ-opioid-receptor agonist (nalfurafine) may be chosen. In desperate cases, patients suitable for transplantation might be set on ‘high urgency’-status, as successful kidney transplantation will relieve patients from CKD-aP.
Publisher
Elsevier Inc,Elsevier Limited
Subject
/ Anti-Inflammatory Agents - therapeutic use
/ Calcium Channel Blockers - therapeutic use
/ Cyclohexanecarboxylic Acids - therapeutic use
/ gamma-Aminobutyric Acid - therapeutic use
/ gamma-Linolenic Acid - therapeutic use
/ Humans
/ itch
/ Morphinans - therapeutic use
/ Naltrexone - therapeutic use
/ Narcotic Antagonists - therapeutic use
/ Pentoxifylline - therapeutic use
/ Pregabalin - therapeutic use
/ Receptors, Opioid, kappa - agonists
/ Renal Insufficiency, Chronic - complications
/ Spiro Compounds - therapeutic use
/ Tacrolimus - therapeutic use
