Skin disorders associated with chronic kidney disease (CKD) can markedly affect a patient's quality of life and can negatively impact their mental and physical health.
Uremic pruritus, which is frequently encountered in patients with stage 3 CKD, is considered to be an inflammatory systemic disease rather than a local skin disorder. Treatment options for uremic pruritus include emollients, topical capsaicin cream, ultraviolet B phototherapy, gabapentin, oral activated charcoal and nalfurafine, a kappa-opioid-receptor agonist.
In some patients, UP occurs intermittently and lasts only several minutes, but other patients suffer from prolonged periods of severe pruritus, which can occur throughout the day and night. The occurrence, duration and intensity of UP can change over time and the itching is usually worst at night. The areas most commonly affected by UP are the back, limbs, chest and head, but 20-50% of patients experience generalized pruritus. External heat, sweat and stress can aggravate UP, and cold or hot showers can alleviate symptoms. Contradictory reports have been published on the acute effect of dialysis on UP; some studies have shown that the itch worsens during dialysis sessions while others have shown an immediate beneficial effect of dialysis on UP. The type of biocompatible dialysis membrane does not seem to affect the incidence of UP, but a recent, noncontrolled study showed the use of polymethylmethacrylate high-flux dialysis membranes to be associated with a significant reduction in pruritus score.
UP has a substantial effect on quality of life, as it causes serious discomfort, anxiety, depression and sleeping disorders. Sleeping disorders cause chronic fatigue, are associated with disturbance of day and night rhythm and they have a negative influence on mental and physical capacity. Recently, both a Japanese study and the DOPPS demonstrated an association between UP and an increased risk of mortality. This effect was lost in the DOPPS when sleep quality was incorporated into the multivariate analysis. Nevertheless, although UP might not be directly causally linked with mortality it is increasingly recognized as an indicator of excess mortality risk in patients with stage 3 CKD.
UP often leads to considerable mechanical skin damage as a result of continuous scratching, with excoriations, superimposed infections and chronic lesions of prurigo nodularis or skin lichenification often occurring. Despite these findings, UP remains an underappreciated complication that adversely affects the quality of life of many patients with stage 3 CKD.
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