Refractory Chronic Kidney Disease-Associated Pruritus: Old Remedies and Novel Agents

Refractory chronic kidney disease associated pruritus (CKDaP) has limited therapeutic options, leading to significant distress, profound sleep disturbance, and reduced quality of life. We describe 2 cases of severe CKDaP in which conventional treatments were unsuccessful and novel therapeutic strategies were employed. The first case involves a patient receiving hemodialysis who achieved significant symptom relief with a subcutaneous lignocaine infusion, delivered using a syringe driver over 2 weeks followed by oral mexiletine. The second case concerns a kidney failure patient managed on the conservative kidney management pathway, who experienced marked improvement following weekly intravenous difelikefalin despite not receiving chronic hemodialysis. These cases underscore the challenges faced by patients and clinicians in managing severe CKDaP and its profound impact on quality of life and emotional distress. Furthermore, these cases highlight the variability in individual treatment responses and the therapeutic potential of repurposed medicines and emphasize the need for further research in this area.