Uremic pruritus

Kidney Int. 2015 Apr;87(4):685-91. doi: 10.1038/ki.2013.454. Epub 2014 Jan 8.


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.

Publication types

  • Review

MeSH terms

  • Acupuncture Therapy
  • Amines / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Calcium Channel Blockers / therapeutic use
  • Cyclohexanecarboxylic Acids / therapeutic use
  • Gabapentin
  • Humans
  • Morphinans / therapeutic use
  • Naltrexone / therapeutic use
  • Narcotic Antagonists / therapeutic use
  • Pentoxifylline / therapeutic use
  • Phototherapy
  • Pregabalin / therapeutic use
  • Pruritus / etiology*
  • Pruritus / therapy*
  • Receptors, Opioid, kappa / agonists
  • Renal Insufficiency, Chronic / complications*
  • Spiro Compounds / therapeutic use
  • Tacrolimus / therapeutic use
  • Thalidomide / therapeutic use
  • Uremia / complications*
  • gamma-Aminobutyric Acid / therapeutic use
  • gamma-Linolenic Acid / therapeutic use


  • Amines
  • Anti-Inflammatory Agents
  • Calcium Channel Blockers
  • Cyclohexanecarboxylic Acids
  • Morphinans
  • Narcotic Antagonists
  • Receptors, Opioid, kappa
  • Spiro Compounds
  • TRK 820
  • Thalidomide
  • Pregabalin
  • gamma-Aminobutyric Acid
  • Naltrexone
  • Gabapentin
  • gamma-Linolenic Acid
  • Pentoxifylline
  • Tacrolimus