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Uremic pruritus

Sidney M Kobrin, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


Pruritus is a common and bothersome symptom among patients with end-stage-renal-disease (ESRD). The pathophysiology is incompletely understood, and it is often difficult to eradicate, although symptoms can usually be mitigated.

Uremic pruritus is discussed in this topic review. A general discussion of pruritus is presented separately. (See "Pruritus: Overview of management".)


The reported prevalence of uremic pruritus in adult hemodialysis patients has varied over the years, and some studies suggest the prevalence may be decreasing with more effective dialysis [1]. Whereas the reported prevalence between 1980 and 1993 was 50 to 90 percent [2-4], subsequent surveys note a lower rate (22 to 57 percent) [5-8]. In one of the largest trials (the Dialysis Outcomes and Practice Patterns Study [DOPPS]), pruritus was experienced by 42 percent of dialysis patients [7]. The prevalence has not been as well studied in peritoneal dialysis patients and in children, but small series suggest that the prevalence is similar between hemodialysis and peritoneal dialysis patients and lower in children (approximately 9 percent) [9-11].


The pathophysiology of uremic pruritus is poorly understood. Hypotheses implicating immunologic and opioidergic systems have been proposed [12].

Immunohypothesis — The immunohypothesis proposes that uremic pruritus is the result of systemic inflammation rather than a local skin disorder [13,14]. Immunomodulating therapies such as ultraviolet B (UVB) phototherapy, thalidomide, and calcineurin inhibitors have been shown to decrease uremic pruritus in some studies [15-17].


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Literature review current through: Sep 2016. | This topic last updated: Feb 6, 2015.
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