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Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
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Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
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Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
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[Pruritus associated chronic kidney disease].

Antoine Lanot1, Diane Kottler2, Clémence Béchade1

  • 1UNICAEN, néphrologie, Normandie université, CHU de Caen Normandie, 14000 Caen, France; UNICAEN, UFR de médecine, Normandie Université, 2, rue des Rochambelles, 14032 Caen cedex, France; ANTICIPE U1086 Inserm-UCN, centre François-Baclesse, 14000 Caen, France.

Nephrologie & Therapeutique
|October 16, 2021
PubMed
Summary

Chronic kidney disease (CKD) pruritus significantly impacts patient quality of life and survival. Gabapentinoids are recommended first-line treatments, with peripheral opioid agonists showing promise for managing this common, yet underestimated, CKD symptom.

Keywords:
Chronic kidney diseaseDialyseDialysisInsuffisance rénale chroniquePrurit associé à la maladie rénale chroniquePrurit urémiquePruritus associated chronic kidney diseaseQuality of lifeQualité de vieUremic pruritus

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Area of Science:

  • Nephrology
  • Dermatology
  • Clinical Pharmacology

Background:

  • Pruritus is a common and debilitating symptom in patients with chronic kidney disease (CKD) undergoing dialysis.
  • It is linked to reduced quality of life, increased comorbidities, and mortality, yet often underestimated by nephrologists.
  • The exact pathophysiology is unclear, involving uremic toxins, neuropathy, inflammation, opioid imbalance, and skin xerosis.

Purpose of the Study:

  • To review the current understanding of CKD-associated pruritus.
  • To discuss potential therapeutic mechanisms and available treatments.
  • To highlight the need for optimized management strategies and further research.

Main Methods:

  • Literature review of studies on CKD-associated pruritus.
  • Analysis of proposed pathophysiological mechanisms.
  • Evaluation of current and emerging therapeutic options.

Main Results:

  • Several mechanisms contribute to CKD pruritus, including uremic toxins, neuropathy, inflammation, and skin xerosis.
  • Optimizing CKD treatment, dialysis, and skin care is crucial before systemic therapy.
  • Gabapentinoids are first-line treatments; peripheral opioid agonists show future potential.

Conclusions:

  • CKD-associated pruritus requires comprehensive management strategies.
  • Current evidence for many therapies is limited by study bias and small sample sizes.
  • Further high-quality trials are needed to establish optimal second-line treatments.