Hemodialysis – talk to doctor if itchy

Hemodialysis – talk to doctor if itchy

People with renal insufficiency who receive hemodialysis often suffer from excruciating itching – about 67 per cent are affected by the symptoms. 1,2 The itching can take on such proportions that it massively restricts the quality of life. Physical well-being, sleep quality and even social relationships can be negatively affected. 1 Nevertheless, many sufferers do not address the topic of itching when visiting the dialysis centre – for various reasons. You can find out here why it is worth talking to your doctor about the symptoms, what can cause itching in kidney failure and what treatment options are available.

Pruritus in renal insufficiency: what is CKD-associated pruritus?

In medicine, CKD-associated pruritus refers to itching (pruritus) that occurs with chronic kidney disease (CKD). The term “uraemic pruritus” is also common.

The manifestations of CKD-associated pruritus are as varied as those affected themselves. The itching can only occur in phases but can also be chronic. It can be limited to certain areas, such as the back or the dialysis arm, but it can also affect the entire body. The intensity also varies from mild to severe. Sometimes, specific triggers, such as heat, cold, stress or physical activity, worsen the symptoms. 3

In all cases, however, it is typical of the itching associated with renal insufficiency that it does not cause any externally visible skin changes, such as a rash. Only increased scratching can lead to redness and skin injuries in the affected areas.

What are the causes behind itching in renal failure?

The causes of itching in renal insufficiency have yet to be clarified. However, several factors probably play a role in the development:

  1. Pain signals:  The opioid system in the body consists of a neural network that produces and releases the body’s opioids. These play a role in pain suppression. In the case of renal insufficiency, this system can be disturbed. Misdirected pain signals then cause the itching.
  2. Immune system:  In the case of renal insufficiency, the immune system can become unbalanced. 3 This can increase inflammation in the skin, which can lead to chronic itching. 3
  3. Signal transmission of the nerves: In the case of renal insufficiency, nerve impulses in the skin can be misdirected. In concrete terms, this means nerve signals are sent from the skin to the brain without a triggering stimulus, or the nerves overreact to stimuli three and send too many signals. This can also cause itching.
  4. Dry skin:  Many people with chronic kidney disease suffer from dry skin, which can cause itching.
  5. Dialysis:  If the dialysis is not optimally adjusted, toxins (so-called toxins) can accumulate under the skin. These can then cause itching. 3

CKD-associated pruritus is particularly common in people who receive hemodialysis.

People with renal insufficiency who receive hemodialysis often suffer from excruciating itching – about 67 per cent are affected by the symptoms. 1,2 The itching can take on such proportions that it massively restricts the quality of life. Physical well-being, sleep quality and even social relationships can be negatively affected. 1 Nevertheless, many sufferers do not address the topic of itching when visiting the dialysis centre – for various reasons. You can find out here why it is worth talking to your doctor about the symptoms, what can cause itching in kidney failure and what treatment options are available.

Pruritus in renal insufficiency: what is CKD-associated pruritus?

In medicine, CKD-associated pruritus refers to itching (pruritus) that occurs with chronic kidney disease (CKD). The term “uraemic pruritus” is also common.

The manifestations of CKD-associated pruritus are as varied as those affected themselves. The itching can only occur in phases but can also be chronic. It can be limited to certain areas, such as the back or the dialysis arm, but it can also affect the entire body. The intensity also varies from mild to severe. Sometimes, specific triggers, such as heat, cold, stress or physical activity, worsen the symptoms. 3

In all cases, however, it is typical of the itching associated with renal insufficiency that it does not cause any externally visible skin changes, such as a rash. Only increased scratching can lead to redness and skin injuries in the affected areas.

What are the causes behind itching in renal failure?

The causes of itching in renal insufficiency have yet to be clarified. However, several factors probably play a role in the development:

  1. Pain signals:  The opioid system in the body consists of a neural network that produces and releases the body’s opioids. These play a role in pain suppression. In the case of renal insufficiency, this system can be disturbed. Misdirected pain signals then cause the itching.
  2. Immune system:  In the case of renal insufficiency, the immune system can become unbalanced. 3 This can increase inflammation in the skin, which can lead to chronic itching. 3
  3. Signal transmission of the nerves: In the case of renal insufficiency, nerve impulses in the skin can be misdirected. In concrete terms, this means nerve signals are sent from the skin to the brain without a triggering stimulus, or the nerves overreact to stimuli three and send too many signals. This can also cause itching.
  4. Dry skin:  Many people with chronic kidney disease suffer from dry skin, which can cause itching.
  5. Dialysis:  If the dialysis is not optimally adjusted, toxins (so-called toxins) can accumulate under the skin. These can then cause itching. 3

CKD-associated pruritus is particularly common in people who receive hemodialysis.

What can you do about the itching?

It is best to seek medical advice for information about drug treatment options for itching. Various medications can treat the itching – for example, antihistamines or ointments with glucocorticoids. There is currently 

no approved drug specifically for the treatment of CKD-associated pruritus. However, there will soon be a new therapy option that can be used directly during the dialysis session for hemodialysis patients.

In addition to drug therapy, the following tips and home remedies can help relieve the itching:

  1. Proper care: If you suffer from itching, try to take short baths or showers, use warm water instead of hot, and use as little shower gel and soap as possible. This reduces the additional stress on the skin. Moisturizing creams help against dry skin. Avoid preservatives and fragrances in care products that can trigger allergies, and choose mild, pH-neutral products. When choosing the right care products, seek medical advice or ask the specialist staff at the pharmacy. 7
  2. Cooling:  If only a few body parts are affected by the itching, it helps to cool them down in a targeted manner. This can be done with cool packs wrapped in a kitchen towel, a wet washcloth from the fridge, or chilled moisturizer. However, avoid excessive cold stimuli (e.g. a cold pack directly on the skin) to avoid frostbite. Light clothing and bed linen can help prevent heat build-up on the skin and worsen the itching. 7
  3. Low-phosphate diet: In hemodialysis patients, the kidneys can only insufficiently regulate the phosphate level in the blood. However, a high phosphate level can increase the itching. Therefore, make sure you eat a low-phosphate diet. Nutritional advice for people with kidney disease can help here. 8.9
  4. Don’t Scratch: Although hard, try not to scratch your itchy skin. In the worst case, this can lead to skin injuries and infections in the affected areas. Rub or pat the skin instead. 7
  5. Talking helps: Besides medical advice, you should also talk to friends or family. Talking about the problems can make a lot of things easier. Talking to other hemodialysis patients can also help, as they often have the same experiences.

Diagnosis of itching – good preparation helps

Itching is worth addressing during the next doctor’s visit for hemodialysis patients. The nurse who takes over the care during the hemodialysis session can also be asked about it.

As a basis for such a conversation, it can be helpful to keep an itching diary. In the run-up to the appointment, it can be precisely documented when and where the itching occurs and how intensely it is perceived. A template for your itching diary, as well as further information on the subject of itching in kidney failure, can be found here.

In addition, within the Miku app developed for dialysis patients, there is the option of keeping an itching diary and finding out more about itching.

After a comprehensive discussion with the doctor about the existing symptoms, blood or allergy tests, for example, are carried out to rule out other diseases that cause the itching. The correct form of therapy will then be selected for you.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *