International Journal of Nephrology and Renovascular Disease (Dec 2022)

Obstacles to Early Diagnosis and Treatment of Pruritus in Patients with Chronic Kidney Disease: Current Perspectives

  • Jha CM,
  • Dastoor HD,
  • Gopalakrishnan N,
  • Holt SG

Journal volume & issue
Vol. Volume 15
pp. 335 – 352

Abstract

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Chandra Mauli Jha,1 Hormaz Dara Dastoor,1 Natrajan Gopalakrishnan,2 Stephen Geoffrey Holt1,3 1SEHA Kidney Care, Abu Dhabi, United Arab Emirates; 2Institute of Nephrology, Madras Medical College, Chennai, India; 3Khalifa University, Abu Dhabi, United Arab EmiratesCorrespondence: Chandra Mauli Jha, PO Box 61358; Al Bateen Post Office, Abu Dhabi, United Arab Emirates, Tel +971 50 1096 345 ; +971 2 55 80 482, Email [email protected]: Chronic kidney disease-associated pruritus (CKD-aP) is a common condition amongst patients with advanced chronic kidney disease (CKD). Several studies have confirmed that more than four out of ten early-stage CKD patients suffer from this condition, while its prevalence among CKD patients on dialysis reaches up to seven out of ten. It is noted to be associated with other disabling symptoms and serious outcomes. It has significant impact on sleep, mood, daily activities, and quality of life of CKD patients, and increased mortality risk of patients on hemodialysis. The Dialysis Outcomes and Practice Patterns Study found 17% higher mortality among patients with moderate to extreme pruritus compared with patients with no or mild pruritus. Despite its high prevalence, ill-effect, and suffering associated with it, CKD-aP remains surprisingly under-reported on the patient’s part and under-recognized by the healthcare team. Even upon being noticed, it remains unattended and poorly treated. Its etiopathogenesis is complex and not fully understood. Many treatment options are available but good quality evidence about most of those is absent, and to date, only two medications are approved for use in this condition. While a validated guideline is very much required for the benefit of the patients and caretakers, further research on several aspects of this issue is required.Keywords: chronic kidney disease, chronic kidney disease-associated pruritus, CKD-aP, pruritus, itching, uremia, uremic pruritus

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