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What Is Pruritus?

Pruritus is the medical term for itchy skin. There are many causes for pruritus, including dry skin, irritation, allergies, and certain medical conditions. Signs of pruritus can include itching, red marks, scratches, dry skin, and leathery or scaly patches of skin. People with end stage renal disease (ESRD) who are on dialysis frequently experience pruritus, which can be uncomfortable. Thankfully, there are skin care recommendations and medications available to manage pruritus.
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How Is Pruritus Related to ESRD

Dry skin is often itchy. People on dialysis have excess fluids removed from their body through regular treatments and may have restrictions on how much fluid they can drink. This can make it difficult to keep skin moist, leading to dry, itchy, and irritable skin. Not having enough dialysis can also lead to itchy skin. Additionally, high levels of phosphorus, calcium, or parathyroid hormone levels in your blood—which can be a concern for people on dialysis—can cause itchy skin. If your doctor has prescribed phosphate binders, be sure to take them as prescribed. Pruritus from chronic kidney disease (CKD) can also be caused by an immune reaction, micro-inflammation, or as a result of neuropathy (damage to nerves).

How Should People with ESRD Care for Their Skin?

Good skin care routines can help your skin stay healthy and may reduce or avoid itchiness. For dry, itchy skin, review these tips for healthier skin and to avoid the itch.

Use smart bathing techniques

Water and many soaps can dry out your skin. Quick showers with warm water can help skin stay moist. Long, hot baths by contrast may dry out your skin. Try using fragrance-free soaps, blot your skin dry after bathing to avoid irritation, and moisturize your skin while it is still damp.

Moisturize regularly

Use moisturizing cream or ointment one to four times a day to help combat dry skin and possibly relieve itchiness. Look for products with ingredients like jojoba oil, dimethicone, glycerin, hyaluronic acid, lanolin, mineral oil, petrolatum, and shea butter. Avoid products that contain alcohol (aside from hand sanitizer), alpha hydroxy acids, fragrances, and retinoids.

Wear gloves

In colder weather, be sure to wear gloves outside for warmth and protection. Additionally, consider wearing rubber gloves while doing dishes or using cleaning supplies.

Wear breathable materials

Natural fabrics like cotton tend to be more breathable than synthetic materials and are gentle on your skin. Be sure to wash clothes with unscented, hypoallergenic detergents.

Learn about Treatment for Pruritus

In addition to maintaining a healthy skin care routine, people with pruritus may want to investigate medications to manage their symptoms. More severe symptoms may require prescription medication.

Korsuva for pruritus

Korsuva is the first FDA-approved drug specifically targeted toward relieving moderate to severe pruritus for people on hemodialysis (HD). Korsuva is not intended for people on peritoneal dialysis as it hasn’t been tested for people using this treatment because it’s administered intravenously. While Korsuva may be a path for people on HD to treat moderate to severe itching, there are some possible side effects such as dizziness, sleepiness, mental confusion, trouble walking, diarrhea, nausea, high potassium, and headache.

Gabapentin for pruritus

Another prescription available is gabapentin. Gabapentin is an anticonvulsant that has been used for the management of neuropathy, seizures, sleep issues, and other conditions such as itching in dialysis patients. It’s important to note that gabapentin has been linked to some severe side effects including possible breathing difficulties. More common side effects include drowsiness, fatigue, risk of falls, and altered mental state.

Why Is It Important to Treat Pruritus?

Pruritus is more than an annoyance. Continued scratching can lead to skin infections that could lead to hospitalization. Pruritus caused by CKD is also associated with increased risk of hospitalization and more significant complications for people with ESRD. Reduce your risk of infection and feel more comfortable in your skin by treating pruritus symptoms and following a skin care routine.

Talk to Your Care Team

If you are experiencing dry, itchy skin, talk to your care team to better understand your symptoms and determine if a new skin care routine or medication may help.

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