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Management of Uremic Pruritus

Pruritus can be defined as a poorly localized unpleasant sensation that elicits the desire to scratch. It is the dominant symptom of skin disease and a frequent manifestation of systemic disease. Of all the systemic disorders, uremia is certainly the most important cause of pruritus. It causes more distress than pain because it is frequently intractable. The association between uremia and pruritus was first reported more than a century ago. The frequency of pruritus has increased dramatically with the advent of dialysis, occuring in 37–90% of hemodialysis patients, 25–76% of peritoneal dialysis patients, and 25–60% of chronic renal failure patients not on dialysis. In this article we will review the therapeutic approaches to uremic pruritus. Before considering the treatment of uremic pruritus, an evaluation should be made to define whether pruritus in a specific patient is caused by uremia or is related to dermatologic or systemic disease that may require a different approach. Once the etiology of pruritus has been established, several therapies can potentially be adopted. Unfortunately none of these treatments is totally satisfactory, an observation that is reflected by the large variety of treatments that have been tried. Treatments can be classified as topical, physical, or systemic (including oral supplementation).