Pruritus in end stage renal disease

In end stage renal disease (ESRD) clients, pruritus can be so severe and intractable, despite scratching, that sleep deprivation and contemplation of suicide can result. The exact etiology of pruritus in ESRD is unknown, but several possible etiologies have been proposed. Assessment tools are available to nurses and clients to grade the severity, frequency, distribution, and sleep deprivation experienced with the itching. Various treatments have been used to manage pruritus in ESRD with limited success. This article reviews the anatomy and physiology of the skin, describes the pathophysiology of pruritus, discusses proposed etiologies, reviews an assessment for an ESRD client with pruritus, and discusses the collaborative management of pruritus in ESRD.