Does Sensipar Cause Itching?
No, Sensipar (cinacalcet) does not cause itching—in fact, itching is a common symptom of chronic kidney disease itself, affecting 42-60% of patients with end-stage renal disease, and cinacalcet is not listed among its documented adverse effects. 1, 2
Understanding the Source of Itching in CKD Patients
The confusion likely arises because patients taking Sensipar have advanced CKD, and uremic pruritus (CKD-associated itching) is one of the most common complications of the underlying kidney disease, not a side effect of cinacalcet therapy. 1, 2
Documented Side Effects of Cinacalcet
The well-established adverse effects of cinacalcet from high-quality meta-analysis evidence include: 3
- Hypocalcemia (7.38-fold increased risk)
- Nausea (2.05-fold increased risk)
- Vomiting (1.95-fold increased risk)
- Diarrhea (1.15-fold increased risk)
Itching is notably absent from this comprehensive list of documented cinacalcet side effects. 3
Why CKD Patients Experience Itching
Prevalence and Mechanism
- CKD-associated pruritus affects 42% of hemodialysis patients and up to 60% of all dialysis patients, making it an intrinsic complication of advanced kidney disease. 1
- The itching is driven by uremia itself (kidney dysfunction), along with secondary hyperparathyroidism, dry skin (xerosis), and metabolic imbalances—not by medications used to treat these conditions. 1, 2
- In two-thirds of patients, the pruritus is generalized, and it typically worsens during summer months or at night. 1, 2
Clinical Impact
- Severe CKD-associated pruritus is associated with increased mortality, hospitalizations, and cardiovascular events in patients with advanced kidney disease. 4
- The condition profoundly disrupts sleep and quality of life. 2, 5
Critical Clinical Distinction
If a patient on Sensipar reports itching, the appropriate clinical response is to recognize and treat uremic pruritus as a manifestation of their underlying CKD, not to discontinue cinacalcet. 1, 2 The British Journal of Dermatology recommends checking urea and electrolytes (renal function) in all patients presenting with generalized pruritus. 1
Evidence-Based Treatment for CKD-Associated Itching
When patients with CKD experience itching, the recommended approach includes: 2, 6
- Gabapentin 100-300 mg after each dialysis session (most effective medication, with 4.95 cm reduction in VAS compared to placebo)
- Pregabalin (also highly effective as a GABA analogue)
- Topical capsaicin 0.025% cream four times daily (marked relief in 14 of 17 patients)
- Ensuring adequate dialysis, normalizing calcium-phosphate balance, and controlling PTH
Antihistamines should be avoided as they have been shown to be ineffective for uremic pruritus. 2, 6
Common Clinical Pitfall
The most important pitfall to avoid is attributing CKD-associated pruritus to cinacalcet therapy and unnecessarily discontinuing a medication that may be preventing parathyroidectomy. 3 Cinacalcet prevents surgical parathyroidectomy in people with CKD stage 5D (relative risk 0.49), which is its primary clinical benefit. 3