From the Guidelines
The six most common symptoms of uremia (azotemia, elevated Blood Urea Nitrogen (BUN) and creatinine levels) are fatigue, nausea and vomiting, pruritus (itching), cognitive dysfunction, sleep disturbances, and muscle cramps. These symptoms are a result of the accumulation of uremic toxins in the body, which can affect various organs and systems, including the bone, heart, vasculature, and lungs 1. The clinical manifestation of uremia can vary, but common symptoms include:
- Fatigue, which is often the earliest and most pervasive symptom, resulting from anemia, metabolic derangements, and accumulation of uremic toxins
- Nausea and vomiting, which typically worsen as kidney function declines due to the buildup of uremic toxins affecting the gastrointestinal tract and central nervous system
- Pruritus, which affects up to 80% of dialysis patients and is caused by calcium-phosphate imbalances, mast cell proliferation, and microinflammation 1
- Cognitive dysfunction, often called "uremic encephalopathy," which manifests as confusion, difficulty concentrating, and memory problems due to neurotoxin accumulation
- Sleep disturbances, including insomnia and sleep apnea, which result from uremic toxins affecting sleep centers in the brain and concurrent conditions like restless leg syndrome
- Muscle cramps, particularly in the legs, which occur due to electrolyte imbalances and altered neuromuscular function These symptoms can be managed and improved with dialysis initiation or kidney transplantation, as well as other treatments aimed at removing uremic toxins and restoring metabolic balance 1. Early recognition of these symptoms is crucial to prompt timely intervention and improve quality of life for patients with kidney failure.
From the Research
Uremic Symptoms
The top 6 most common symptoms of uremia (azotemia, elevated Blood Urea Nitrogen (BUN) and creatinine levels) are:
- Anorexia
- Nausea/vomiting
- Pruritus
- Sleepiness
- Difficulty concentrating
- Fatigue
Prevalence of Uremic Symptoms
These symptoms are prevalent in patients undergoing dialysis, with studies showing that:
- 44-44% of patients experience anorexia 2
- 36-43% of patients experience nausea/vomiting 2
- 50-90% of patients experience pruritus 3, 2, 4
- 68-86% of patients experience sleepiness 2
- 55-57% of patients experience difficulty concentrating 2
- 77-89% of patients experience fatigue 2
Clinical Characteristics
Uremic pruritus is a common and sometimes severe complication of chronic renal failure, affecting 50-90% of patients undergoing peritoneal dialysis or hemodialysis 3, 4. The pathogenesis of uraemic pruritus is multifactorial, involving uraemia-related abnormalities, accumulation of uraemic toxins, systemic inflammation, cutaneous xerosis, and common co-morbidities 5.