Pathways for Diagnosing and Treating CKD-Associated Pruritus: A Narrative Review

Area of Science:

• Nephrology
• Dermatology
• Clinical Practice Guidelines

Background:

• Chronic kidney disease-associated pruritus (CKD-aP) is a prevalent, persistent, and distressing symptom in patients with kidney disease.
• CKD-aP significantly impairs health-related quality of life (QoL) and is frequently underdiagnosed and undertreated.
• Effective management strategies are crucial to alleviate symptom burden and improve patient outcomes.

Purpose of the Study:

• To provide healthcare providers with practical guidance for the identification, assessment, and management of CKD-aP.
• To reduce the symptom burden of CKD-aP and enhance patient-important outcomes, including QoL.
• To offer a framework for proactive assessment and severity scoring of CKD-aP.

Main Methods:

• A narrative review developed by a panel of nephrologists and researchers from Canada and the United States.
• Discussion of key topics based on the best available data, current treatment guidelines, and clinical experiences.
• Development of a 3-pillar framework for CKD-aP assessment: screening, intensity assessment, and QoL impact.

Main Results:

• Guidance covers screening methods, severity assessment, and management strategies for CKD-aP.
• Management includes optimizing dialysis, achieving mineral metabolism targets, and non-pharmacological approaches like skin hydration.
• Evidence-based pharmacological treatments like difelikefalin and gabapentin are recommended over antihistamines.

Conclusions:

• A systematic approach to screening, assessment, and management is essential for CKD-aP.
• Optimizing general CKD care and employing targeted interventions are key to managing pruritus.
• Further research is needed, particularly head-to-head clinical trials, to refine treatment strategies.