title: Uremic pruritus.
abstract: 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.
authors.affiliation: Department of Nephrology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mettang
authors.affiliation: Department of Medicine 1, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Kremer
mesh_terms: D015670:Acupuncture Therapy; D000588:Amines / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D009019:Morphinans / Q000627:therapeutic use; D009271:Naltrexone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D010431:Pentoxifylline / Q000627:therapeutic use; D010789:Phototherapy; D000069583:Pregabalin / Q000627:therapeutic use; D011537:Pruritus / Q000209:etiology* / Q000628:therapy*; D017473:Receptors, Opioid, kappa / Q000819:agonists; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D013141:Spiro Compounds / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D013792:Thalidomide / Q000627:therapeutic use; D014511:Uremia / Q000150:complications*; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use; D017965:gamma-Linolenic Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000893:Anti-Inflammatory Agents; D002121:Calcium Channel Blockers; D003509:Cyclohexanecarboxylic Acids; D009019:Morphinans; D009292:Narcotic Antagonists; D017473:Receptors, Opioid, kappa; D013141:Spiro Compounds; C111212:TRK 820; D013792:Thalidomide; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D009271:Naltrexone; D000077206:Gabapentin; D017965:gamma-Linolenic Acid; D010431:Pentoxifylline; D016559:Tacrolimus