Can chronic kidney disease (CKD) or hypertension cause generalized itchiness?

Can Chronic Kidney Disease or Hypertension Cause Generalized Itchiness?

Yes, chronic kidney disease is a well-established cause of generalized itchiness (uremic pruritus), affecting 42-60% of patients with end-stage renal disease, while hypertension itself does not directly cause generalized itching. 1, 2

Chronic Kidney Disease and Pruritus

Prevalence and Clinical Features

• CKD-associated pruritus occurs in 42% of hemodialysis patients and up to 60% of all dialysis patients, making it one of the most common complications of advanced kidney disease 1, 2
• The condition can range from mild intermittent irritation to severe, intractable itching that profoundly disrupts sleep and quality of life 1, 3
• In two-thirds of patients, the pruritus is generalized, while in others it primarily affects the back, face, or arteriovenous fistula arm 1
• Symptoms typically worsen during summer months or at night, and some patients experience itching during or immediately after dialysis treatment 1, 3

When CKD Causes Itching

• Pruritus can occur in non-dialysis patients with stage 3-5 CKD, with increasing prevalence as kidney function worsens 2
• ESRD may be asymptomatic except for pruritus, making it essential to check urea and electrolytes in any patient presenting with generalized pruritus without obvious dermatologic cause 1
• The severity is generally lower in patients on peritoneal dialysis compared to hemodialysis 1

Mechanism and Associated Factors

• The pathophysiology involves multiple factors including inflammation, uremic toxins, and neurological changes, though no single mechanism fully explains the condition 2, 4
• Dry skin (xerosis) is the most common cutaneous finding in dialysis patients and may lower the threshold for itch, even if not the primary cause 1, 3
• Secondary hyperparathyroidism often accompanies ESRD and may contribute to pruritus, though parathyroid hormone levels do not consistently correlate with itch severity 1

Hypertension and Pruritus

Hypertension alone does not cause generalized pruritus. 1

However, there is an important indirect relationship:

• Secondary polycythemia due to kidney disease can cause generalized pruritus, and kidney disease itself causes hypertension 1
• When evaluating polycythemia as a cause of pruritus, secondary causes should be investigated through renal and liver function tests, as kidney disease can drive both the polycythemia and the hypertension 1

Clinical Approach to Evaluation

When to Suspect CKD as the Cause

• Check urea and electrolytes (renal function) in all patients presenting with generalized pruritus without underlying dermatosis 1
• Consider CKD even in the absence of other symptoms, as pruritus may be the only manifestation 1
• Patients with generalized pruritus should not undergo routine endocrine investigations unless additional clinical features suggest endocrine disease 1

Important Pitfall

• Do not assume that controlling hypertension will resolve pruritus—the itching is related to kidney dysfunction itself, not the blood pressure elevation 1
• While hypertension is both a cause and complication of CKD and should be carefully controlled, this addresses disease progression rather than pruritus directly 1