Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Chronic Kidney Disease-Associated Pruritus

  • Chapter
  • First Online:
Pruritus

Abstract

Chronic kidney disease-associated pruritus (CKD-associated pruritus, formerly named “uraemic pruritus”) remains a frequent and sometimes tormenting problem in patients with advanced or end-stage renal disease.1 Many attempts have been made to relieve this bothersome symptom in affected patients, but with limited success in general. After a new treatment option is reported to be effective, only a little time elapses before conflicting results concerning CKD-associated pruritus are published. In the meantime patients’ and physicians’ mood changes from euphoria to disillusionment. This happened with erythropoetin2, 3 and naltrexone4, 5 as the last propagated treatment modalities in this respect.

The main obstacle in the effort to create effective treatment modalities is the incomplete knowledge of the underlying pathophysiological mechanisms. Furthermore, given the great clinical heterogeneity of CKD-associated pruritus, systematic studies are hard to obtain and therefore sparse.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Mettang T, Fischer FP, Kuhlmann U. Urämischer pruritus - pathophysiologische und therapeutische konzepte. Dtsch Med Wschr. 1996;121:1025-1031.

    Article  PubMed  CAS  Google Scholar 

  2. De Marchi S, Cecchin E, Villalta D, Sepiacci G, Santini G, Bartoli E. Relief of pruritus and decreases in plasma histamine concentrations during erythropoietin therapy in patients with uremia. N Engl J Med. 1992;326:969-974.

    Article  PubMed  Google Scholar 

  3. Balaskas EV, Uldall RP. Erytropoietin does not improve uremic pruritus. Perit Dial Int. 1992;12:330-331.

    PubMed  CAS  Google Scholar 

  4. Peer G, Kivity S, Agami O, et al. Randomised crossover trial of naltrexone in uraemic pruritus. Lancet. 1996;348:1552-1554.

    Article  PubMed  CAS  Google Scholar 

  5. Pauli-Magnus C, Mikus G, Alscher DM, et al. Naltrexone does not relieve uremic pruritus: results of a randomized, placebo-controlled crossover-study. J Am Soc Nephrol. 2000;11:514-519.

    PubMed  CAS  Google Scholar 

  6. Morvay M, Marghescu S. Hautveränderungen bei Haemodialysepatienten. Med Klin. 1988;83:507-510.

    CAS  Google Scholar 

  7. Ponticelli C, Bencini PL. Uremic pruritus: a review. Nephron. 1992;60:1-5.

    Article  PubMed  CAS  Google Scholar 

  8. Gilchrest GA, Stern RS, Steinman TI, Brown RS, Arndt KA, Anderson WW. Clinical features of pruritus among patients undergoing maintenance hemodialysis. Arch Dermatol. 1982;118:154-156.

    Article  PubMed  CAS  Google Scholar 

  9. Young AW, Sweeney EW, David DS, et al. Dermatologic evaluation of pruritus in patients on hemodialysis. N.Y. St. J. Med. 1973;73:2670-2674.

    Google Scholar 

  10. Mettang T, Fritz P, Weber J, Machleidt C, Hübel E, Kuhlmann U. Uremic pruritus in patients on hemodialysis or Continuous Ambulatory Peritoneal Dialysis (CAPD). The role of plasma histamine and skin mast cells. Clin Neprol. 1990;34:136-141.

    CAS  Google Scholar 

  11. Duque MI, Thevarajah S, Chan YH, Tuttle AB, Freedman BI, Yosipovitch G. Uremic pruritus is associated with higher kt/V and serum calcium concentration. Clin Nephrol. 2006;66:184-191.

    PubMed  CAS  Google Scholar 

  12. Narita I, Alchi B, Omori K, et al. Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney Int. 2006;69:1626-1632.

    Article  PubMed  CAS  Google Scholar 

  13. Pisoni RL, Wikström B, Elder SJ, et al. Pruritus in haemodialysis patients: international results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2006;21:3495-3505.

    Article  PubMed  Google Scholar 

  14. Schwab M, Mikus G, Mettang T, Pauli-Magnus C, Kuhlmann U. Arbeitsgemeinschaft für Pädiatrische Nephrologie: Urämischer Pruritus im Kindes- und Jugendalter. Z Kinderheilkd. 1999;147:232.

    Google Scholar 

  15. Massry S, Popovzer MM, Coburn JM, Mokoff DL, Maxwell MH, Kleeman CR. 1968 Interactable pruritus as a manifestation of secondary hyperparathyroidism in uremia. N Engl J Med. 1968;279:697-700.

    Article  PubMed  CAS  Google Scholar 

  16. Hampers CL, Katz AI, Wilson RE, Merrill JP. Disappearance of uremic itching after subtotal parathyreoidectomy. NEJM. 1968;279:695-697.

    Article  PubMed  CAS  Google Scholar 

  17. Stahle-Bäckdahl M, Hägermark O, Lins LE, Törring O, Hilliges M, Johansson O. Experimental and immunohistochemical studies on the possible role of parathyroid hormone in uremic pruritus. J. Intern. Med. 1989;225:411-415.

    Article  PubMed  Google Scholar 

  18. Blachley JD, Blankenship DM, Menter A, Parker TF III, Knochel JP. Uremic pruritus: skin divalent ion content and response to ultraviolet phototherapy. Am J Kidney Dis. 1985;5:237-241.

    PubMed  CAS  Google Scholar 

  19. Stockenhuber F, Kurz RW, Sertl K, Grimm G, Balcke P. Increased plasma histamine in uremic pruritus. Clin Sci. 1990;79/5:477-482.

    PubMed  CAS  Google Scholar 

  20. Hiroshige K, Kabashima N, Takasugi M, Kuroiwa A. Optimal dialysis improves uremic pruritus. Am J Kidney Dis. 1995;25:413-419.

    Article  PubMed  CAS  Google Scholar 

  21. Dimkovic N, Djukanovic L, Radmilovic A, Bojic P, Juloski T. Uremic pruritus and skin mast cells. Nephron. 1992;61:5-9.

    Article  PubMed  CAS  Google Scholar 

  22. Yosipovitch G, Duque MI, Patel TS, et al. . Skin barrier structure and function and their relationship to pruritus in end-stage renal disease. Nephrol Dial Transplant. 2007;22:3268-3272.

    Article  PubMed  Google Scholar 

  23. Szepietowski JC, Reich A, Schwartz RA. Uraemic xerosis. Nephrol Dial Transplant. 2004;19:2709-2712.

    Article  PubMed  Google Scholar 

  24. Gilchrest BA, Rowe JW, Brown RS, Steinman TI, Arndt KA. Ultraviolet phototherapy of uremic pruritus. Long-term results and possible mechanisms of action. Ann Intern Med. 1979;91:17-21.

    PubMed  CAS  Google Scholar 

  25. Garssen J, Vandebriel RJ, DeGruijl FR, et al. UVB exposure-induced systemic modulation of Th1- and Th2-mediated immune responses. Immunology. 1999;97:506-514.

    Article  PubMed  CAS  Google Scholar 

  26. Hiroshige K, Kabashima N, Takasugi M, Kuroiwa A. Optimal dialysis improves uremic pruritus. Am J Kidney Dis. 1995;25:413-419.

    Article  PubMed  CAS  Google Scholar 

  27. Rousseau Y, Haeffner-Cavaillon N, Poignet JL, Meyrier A. Carreno: in vivo intracellular cytokine production by leukocytes during hemodialysis. Cytokine. 2000;12:506-517.

    Article  PubMed  CAS  Google Scholar 

  28. Silva SRB, Viana PCF, Lugon NV, Hoette M, Ruzany F, Lugon JR. Thalidomide for the treatment of uremic pruritus: a crossover randomized double-blind trial. Nephron. 1994;67:270-273.

    Article  PubMed  CAS  Google Scholar 

  29. Pauli-Magnus C, Klumpp S, Alscher D, Kuhlmann U, Mettang T. Short-term efficacy of tacrolimus ointment in severe uremic pruritus. Perit Dial Int. 2000;6:802-803.

    Google Scholar 

  30. McHugh SM, Rifkin IR, Deigghton J, et al. The immunosuppressive drug thalidomide induces T helper cell type 2 (Th2) and concomitantly inhibits Th1 cytokine production in mitogen- and antigen-stimulated human peripheral blood mononuclear cell cultures. Clin Exp Immunol. 1995;99:160-167.

    Article  PubMed  CAS  Google Scholar 

  31. Suthanthiran M, Strom TB. Renal transplantation. N Engl J Med. 1994;331:365-376.

    Article  PubMed  CAS  Google Scholar 

  32. Altmeyer P, Kachel HG, Schäfer G, Faßbinder W. Normalisierung der urämischen Hautveränderungen nach Nierentransplantation. Hautarzt. 1986;37:217-221.

    PubMed  CAS  Google Scholar 

  33. Call TG, Creagan ET, Frytak S, et al. Phase I trial of combined interleukin-2 with lev in patients with advanced malignant disease. Am J Clin Oncol. 1994;17:344-347.

    Article  PubMed  CAS  Google Scholar 

  34. Darsow U, Scharein E, Bromm B, Ring J. Skin testing of the pruritogenic activity of histamine and cytokines (interleukin-2 and tumour necrosis factor-alpha) at the dermo-epidermal junction. Br J Dermatol. 1997;137:415-417.

    Article  PubMed  CAS  Google Scholar 

  35. Virga G, Visentin I, La MV, Bonadonna A. Inflammation and pruritus in haemodialysis patients. Nephrol Dial Transplant. 2002;17:2164-2169.

    Article  PubMed  CAS  Google Scholar 

  36. Kimmel M, Alscher DM, Dunst R, et al. The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients. Nephrol Dial Transplant. 2006;21:749-755.

    Article  PubMed  CAS  Google Scholar 

  37. Reiz S, Westberg M. Side effects of epidural morphine. Lancet. 1980;2:203-204.

    Article  PubMed  CAS  Google Scholar 

  38. Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology. 1984;62:276-310.

    Google Scholar 

  39. Bergasa NV, Jones EA. The pruritus of cholestasis: potential pathogenic and therapeutic implications of opioids. Gastroenterology. 1995;108:1582-8.

    Article  Google Scholar 

  40. Bergasa NV, Alling DW, Vergalla J, Jones EA. Cholestasis in the male rat is associated with naloxone-reversible antinociception. J Hepatol. 1994;20:85-90.

    Article  PubMed  CAS  Google Scholar 

  41. Bergasa NV, Alling DW, Talbot TL, et al. Effects of naloxone infusion in patients with the pruritus of cholestasis: a double-blind randomised controls trial. Ann Intern Med. 1995;123:161-167.

    PubMed  CAS  Google Scholar 

  42. Bergasa NV, Schmitt JM, Talbot TL, et al. Open-label trial of oral nalmefene therapy for the pruritus of cholestasis. Hepatology. 1998;27:679-684.

    Article  PubMed  CAS  Google Scholar 

  43. Bergasa NV, Rothman RB, Vergalla J, Xu H, Swain MG, Jones EA. Central mu-opioid-receptors are down-regulated in a rat model of acute cholestasis. J Hepatol. 1992;15:220-224.

    Article  PubMed  CAS  Google Scholar 

  44. Thornton JR, Losowsky MS. Opioid peptides and primary biliary cirrhosis. Br Med J. 1988;297:1501-1504.

    Article  CAS  Google Scholar 

  45. Andersen LW, Friedberg M, Lokkegaard N. Naloxone in treatment of uremic pruritus: a case history. Clin Nephrol. 1984;21:355-356.

    PubMed  CAS  Google Scholar 

  46. Gianni LM, Sulli MM. Topical tacrolimus in the treatment of atopic dermatitis. Ann Pharmacother. 2001;35:943-946.

    Article  PubMed  CAS  Google Scholar 

  47. Kuypers DR, Claes K, Evenepoel P, Maes B, Vanrenterghem Y. A prospective proof of concept study of the efficacy of tacrolimus ointment on uraemic pruritus (UP) in patients on chronic dialysis therapy. Nephrol Dial Transplant. 2004;19:1895-1901.

    Article  PubMed  CAS  Google Scholar 

  48. Chen YC, Chiu WT, Wu MS. Therapeutic effect of topical gamma-linolenic acid on refractory uremic pruritus. Am J Kidney Dis. 2006;48:69-76.

    Article  PubMed  CAS  Google Scholar 

  49. Wikström B, Gellert R, Ladefoged SD, et al. Kappa-opioid system in uremic pruritus: multicenter, randomized, double-blind, placebo-controlled clinical studies. J Am Soc Nephrol. 2005;16:3742-3747.

    Article  PubMed  Google Scholar 

  50. Dawn AG, Yosipovitch G. Butorphanol for treatment of intractable pruritus. Am Acad Dermatol. 2006;54:527-531.

    Article  Google Scholar 

  51. Gunal AI, Ozalp G, Yoldas TK, Gunal SY, Kirciman E, Celiker H. Gabapentin therapy for pruritus in haemodialysis patients: a randomized, placebo-controlled, double-blind trial. Nephrol Dial Transplant. 2004;19:3137-3139.

    Article  PubMed  CAS  Google Scholar 

  52. Mettang T, Krumme B, Bohler J, Roeckel A. Pentoxifylline as treatment for uraemic pruritus - an addition to the weak armentarium for a common clinical symptom? Nephrol Dial Transplant. 2007;22:2727-2728.

    Article  PubMed  CAS  Google Scholar 

  53. Tan JKL, Haberman HF, Coldman AJ. Identifying effective treatments for uremic pruritus. J Amer Acad Dermatol. 1991;25:811-818.

    Article  CAS  Google Scholar 

  54. Baldo A, Sammarco E, Plaitano R, Martinelli V. Monfrecola. Narrowband (TL-01) ultraviolet B phototherapy for pruritus in polycythaemia vera. Br J Dermatol. 2002;147:979-981.

    Article  PubMed  CAS  Google Scholar 

  55. Lee E, Koo J. Berger: UVB phototherapy and skin cancer risk: a review of the literature. Int J Dermatol. 2005;44:355-360.

    Article  PubMed  Google Scholar 

  56. Ulrich C, Stockfleth E. Azathioprine, UV light, and skin cancer in organ transplant patients - do we have an answer? Nephrol Dial Transplant. 2007;22:1027-1029.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nephrology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany

    Thomas Mettang

Authors
  1. Thomas Mettang
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Dept. Dermatologie, CHU Brest, Brest, 29200, France

    Laurent Misery

  2. Medizinische Einrichtungen, Klinik und Poliklinik für, Universitätsklinikum Münster, Von-Esmarch-Str. 56, Münster, 48149, Germany

    Sonja Ständer

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag London Limited

About this chapter

Cite this chapter

Mettang, T. (2010). Chronic Kidney Disease-Associated Pruritus. In: Misery, L., Ständer, S. (eds) Pruritus. Springer, London. https://doi.org/10.1007/978-1-84882-322-8_27

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-322-8_27

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-321-1

  • Online ISBN: 978-1-84882-322-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation