From the Guidelines
The best treatment for pruritus in renal failure involves ensuring adequate dialysis, normalizing calcium-phosphate balance, controlling parathyroid hormone levels, correcting anemia with erythropoietin, and using simple emollients, with consideration of capsaicin cream, topical calcipotriol, or oral gabapentin as additional treatment strategies, as recommended by the British Association of Dermatologists' guidelines 1. The management of pruritus in renal failure is complex and multifaceted, requiring a stepwise approach that addresses underlying factors contributing to the condition.
- Ensuring adequate dialysis is crucial, as pruritus is more common in underdialysed patients, and increasing the dialysis dose may improve symptoms 1.
- Normalizing calcium-phosphate balance and controlling parathyroid hormone levels are also important, as secondary and tertiary hyperparathyroidism often accompany end-stage renal disease and may contribute to pruritus 1.
- Correcting anemia with erythropoietin can help reduce pruritus, and using simple emollients is essential for managing dry skin (xerosis), which is a common cutaneous sign in patients on dialysis 1.
- Additional treatment strategies may include capsaicin cream, topical calcipotriol, or oral gabapentin, which have been shown to be effective in reducing pruritus in some patients 1.
- Phototherapy, particularly broadband (BB)-UVB phototherapy, has also been shown to be effective in treating uraemic pruritus, with a meta-analysis of RCTs concluding that BB-UVB was the treatment of choice 1.
- Renal transplantation is the only definite treatment for uraemic pruritus, and patients should be considered for transplantation if possible 1. It is essential to note that no single treatment has been shown to be overwhelmingly effective, and a multifaceted approach that targets the complex pathophysiology of renal pruritus is necessary to achieve optimal results 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Pruritus of Renal Failure
- The treatment of pruritus in renal failure patients can include ensuring optimization of dialysis adequacy and achieving mineral metabolism targets, such as calcium, phosphate, and parathyroid hormone levels 2.
- Patients should be counseled on adequate skin hydration and other non-pharmacological strategies to reduce pruritus, and antihistamines should be avoided in favor of evidence-based treatments 2.
- Gabapentin has been shown to be a promising and well-tolerated treatment option for patients with uremic pruritus, with a recommended maintenance post-hemodialysis dose of 100-300 mg 3, 4, 5, 6.
- Other treatment options that may be effective include difelikefalin, nalfurafine, topical therapies, type B ultraviolet light phototherapy, acupuncture, and opioid-receptor modulators 2, 5, 6.
Key Considerations
- The pathogenesis of uremic pruritus is not completely understood, but it is thought to involve a complex interplay among cutaneous biology and the nervous and immune systems 6.
- Uremic pruritus can have a significant impact on quality of life, and treatment outcomes are often unsatisfactory, highlighting the need for further research and development of effective therapies 5, 6.
- A 3-pillar framework for proactive assessment and severity scoring in CKD-associated pruritus has been proposed, including systematic screening, assessment of pruritus intensity, and understanding the impact on the patient's quality of life 2.