Fast Facts: Kidney Itch: CKD-associated pruritus: under-recognized and under-treated

By H. Rayner and N. Sukul

Chronic kidney disease-associated pruritus, also known as uremic pruritus and in this book called ‘kidney itch’, is defined as itching suffered by people with chronic kidney disease who have no other condition to explain it. Repeated scratching causes trauma, bleeding and, eventually, scarring of the skin. Kidney itch can also have far-reaching effects on quality of life, with patients’ work and social life commonly affected. Even though kidney itch is common, it often goes undiagnosed, and when recognized, it is often inadequately treated or not treated at all. 'Fast Facts: Kidney Itch' describes the problem of kidney itch in detail, documents its impact on people’s lives, reviews the current understanding of its pathophysiology, and then sets out an evidence-based approach to its assessment and management. Table of Contents: • Clinical features • Causes • How common is kidney itch and who is most at risk? • The wider impact • Approach to management

• Language: English
• Publisher: S. Karger
• Release date: Mar 31, 2022
• ISBN: 9783318065138

Book preview

1Clinical features

Pruritus associated with chronic kidney disease (CKD), also known as uremic pruritus or ‘kidney itch’, is defined as itching suffered by people with CKD who have no other condition to explain it.

While itching is a normal sensation, kidney itch can be an intense and extremely bothersome symptom.

The diagnosis of kidney itch is primarily one of exclusion. By definition, no local or systemic cause for itching is evident other than CKD. Unfortunately, there is no diagnostic test for the condition, but some features are frequently reported by sufferers and their presence gives greater confidence in the diagnosis.

Areas affected. The areas of skin involved are often large, bilaterally symmetrical and do not follow dermatomes. They can be generalized or localized to the back, face, chest or forearms. The affected region can move from week to week.¹

Intensity. Sufferers of severe itch have an irresistible urge to scratch, often vigorously, and sometimes use a back scratcher to reach inaccessible parts of the body.

The intensity of itching is variable, ranging from sporadic discomfort to overwhelming irritation and restlessness. It rarely goes away completely, and symptoms can continue for years. Sufferers can become preoccupied with the sensation of itching and hypervigilant towards it.

I didn’t want to do much during the day; I’d rather just concentrate on not itching.

Timing. The itch varies in severity at different times of the day. One-third of affected people are most bothered at night, when they are warm in bed.² They may scratch while they are asleep and discover blood stains on the bed linen or bedclothes in the morning.

There is little association with the timing of hemodialysis; half of affected people are bothered throughout the day, and for two-thirds there is no relation to their dialysis treatment.²

Triggers and alleviating factors. The itch can be triggered by contact with clothing or furniture.

"I would try not to wear a bra because the straps with constant contact on my skin were driving me up the