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Itching, or pruritus, is a common symptom in people with advanced chronic kidney disease (CKD) and those undergoing hemodialysis. You may also hear this referred to as chronic kidney disease-associated pruritus or CKD-aP.

While a nephrologist or kidney doctor will likely oversee your treatment related to chronic kidney disease, you may want to consult a dermatologist if you’re experiencing skin-related issues like itching or dry skin.

If you have chronic kidney disease, you’re not alone in having questions about symptoms related to your condition. Many people living with this disease want to know why they experience itching, how long it will last, and what they can do to minimize the discomfort.

This article will answer common questions about chronic kidney disease-related itching.

Experts divide kidney disease into five stages, with stage 1 being normal to highly functioning kidneys and stage 5 being kidney failure.

Each stage has various symptoms with degrees of severity. Itching is one of the many symptoms you may experience if you have advanced chronic kidney disease, which generally stages 4 and 5, according to the American Kidney Fund.

According to the American Academy of Dermatology Association (AAD), itchy skin is most common in the advanced stages. While not exclusive to this stage and end-stage renal disease, it is less common in less advanced stages.

Itching is a very common symptom to experience in the advanced stages of kidney disease.

A 2019 literature review found that approximately 40 percent of people with end-stage renal disease experience pruritus. However, some data suggest it may affect as many as 84 percent.

Chronic kidney disease-related itching varies from person to person. For example, itching may cause sporadic discomfort in some people or constant restlessness throughout the night and day in others.

In general, CKD-aP often affects the chest, face, and limbs, but it can appear anywhere on the body. It’s more common on both sides of the body, but it can also be generalized or localized, like on the face.

CKD-aP can make an appearance without any other skin disease. But it often happens in people who also have dry skin or xerosis (abnormally dry skin and membranes).

If you experience very dry skin in addition to itching, you may notice your skin is more prone to cracking and bleeding, which affects how your skin looks and feels.

Many people with CKD-aP experience sleep disruption and reduced social functioning. Both can contribute to a lower quality of life, especially if moods are impacted by lack of sleep and restlessness, according to a 2017 study.

There isn’t a one-size-fits-all approach to treating CKD-related itching. Some people may find help quickly, while others will run through all the treatment options only to feel minimal relief.

It’s critical to work with your kidney doctor along with a board certified dermatologist familiar with this type of itching.

Overall, CKD-associated pruritus is often treated using topical and systemic therapies.

Topical therapies may include:

  • topical capsaicin cream
  • emollients
  • tacrolimus cream
  • topical corticosteroids
  • doxepin cream
  • menthol

Systemic therapies may include:

  • antihistamines
  • antidepressants (SSRIs)
  • µ-opioid receptor antagonists
  • selective κ-opioid receptor agonist
  • anticonvulsants (gabapentin and pregabalin)
  • thalidomide

Two other treatments that have shown success are gamma-linolenic acid and ultraviolet B light therapy.

In 2021, the Food and Drug Administration (FDA) approved a drug to treat moderate-to-severe itching in people with CKD who are undergoing dialysis. Korsuva, an injection that is administered 3 times a week after each dialysis, is the first therapy approved by the FDA specifically aimed at treating CKD-related itching.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, itching sometimes occurs because you have too much phosphorus in your blood. If this is the case, your doctor may recommend eating less food with phosphorus, such as beans, nuts, milk, and meat. Alternately, your doctor may prescribe a medication you can take with meals called a phosphate binder.

In addition to treatments specific to CKD-aP, you may find relief by following general guidelines for itch prevention and treatment. During a flare-up, the AAD recommends the following:

  • Use a cooling agent like calamine or menthol on the affected areas.
  • Apply a layer of fragrance-free moisturizer.
  • Place an ice pack or cold, wet cloth on the itchy skin for 5–10 minutes.
  • Try a soothing oatmeal bath.

You can also take preventive measures to help minimize itchy skin. Here are some tips from the AAD:

  • Always use lukewarm water when showering or bathing.
  • Opt for fragrance-free products like soaps, lotions, and detergents — anything that comes into direct contact with your skin.
  • Dress in loose-fitting cotton clothing.
  • Try to avoid extremely dry environments.

Itching, or pruritus, is a common occurrence in the advanced stages of chronic kidney disease and in people undergoing hemodialysis.

Pruritus can be difficult to treat. But your doctor or healthcare professional can recommend prescription and over-the-counter remedies that may help reduce the severity and give you some much-needed relief.