From the Guidelines
Uremia, a condition characterized by impaired renal function, manifests with a range of symptoms including neurological signs and symptoms, pericarditis, anorexia, medically resistant acid-based or electrolyte abnormalities, intractable pruritus, serositis, and acid-base or electrolyte abnormalities.
Common Symptoms of Uremia
- Seizures/change in seizure threshold
- Amenorrhea
- Reduced core body temperature
- Protein-energy wasting
- Insulin resistance
- Heightened catabolism
- Hiccups
- Platelet dysfunction
- Somnolence
- Nausea, vomiting, and appetite suppression are acknowledged symptoms of uremia, as noted in 1.
Assessment and Identification
As recommended in 1, healthcare providers should ask people with progressive CKD about uremic symptoms at each consultation using a standardized validated assessment of uremic symptoms tool.
Management
The management of uremia involves addressing the underlying cause, which often requires initiation of dialysis based on a composite assessment of a person’s symptoms, signs, quality of life, preferences, level of GFR, and laboratory abnormalities, as outlined in 1.
Specific Considerations
- Pruritus is a common feature of patients with end-stage renal disease (ESRD) or chronic kidney disease, and its management may involve ensuring adequate dialysis, normalizing calcium–phosphate balance, controlling PTH to accepted levels, correcting any anaemia with erythropoietin, and using emollients, as discussed in 1.
- Nutritional status should be monitored and maintained in patients on peritoneal dialysis (PD) therapy, with consideration of factors such as serum albumin level, estimation of dietary protein intake (DPI), and subjective global assessment (SGA) score, as highlighted in 1.
From the Research
Uremic Symptoms
The symptoms of uremia, also known as impaired renal function, include:
- Fatigue
- Anorexia
- Pruritus
- Nausea
- Paresthesia
- Pain These symptoms are attributed to the accumulation of organic waste products normally cleared by the kidneys 2, 3.
Prevalence of Uremic Symptoms
The prevalence of uremic symptoms in patients with chronic kidney disease (CKD) is high, with significant variability in patient symptom change over time 2. The most prevalent symptoms at baseline were pain (57%), fatigue (52%), paresthesia (45%), and pruritus (42%) 2.
Association between eGFR and Uremic Symptom Severity
A decrease in eGFR of 5 ml/min per 1.73 m2 was associated with a worsening of the symptom severity score by two points or less for each uremic symptom (P<0.01) 2. The association between eGFR and uremic symptom severity score was nonlinear, with a greater magnitude of uremic symptom worsening when starting from a lower initial eGFR 2.
Metabolites Associated with Uremic Symptoms
Metabolomic profiling identified 26 metabolites whose levels were significantly associated with at least one of the symptoms of fatigue, anorexia, itchiness, nausea, paresthesia, and pain 3. Many of these metabolites exhibited at least a moderate correlation with estimated glomerular filtration rate (Pearson's r≥0.5) 3.
Clinical Management of Uremic Syndrome
The clinical management of uremic syndrome in CKD involves targeting several modifiable factors simultaneously, including cardiovascular disease, metabolic bone disease, inflammation, protein energy wasting, intestinal dysbiosis, anaemia, and neurological and endocrine dysfunction 4.