Itching And Chronic Kidney Disease: What You Need To Know

Chronic kidney disease (CKD) is a long-term condition where kidneys do not work well — their functionality is reduced over time. CKD is often managed using strategies such as dialysis in its final stage. CKD may come along with itchy skin (pruritus).

You are not alone in having questions about specific symptoms of CKD. Many people with CKD often want to know why they may experience itching, how long it lasts, and the best strategies to maximize comfort.

This article will discuss how itching occurs and how you can best manage it.

What is pruritus?

Pruritus¹ refers to the itchy skin you may witness with kidney disease. The feeling may be constant. Thus, it could lower your comfort by disrupting sleep and quality of life. Several studies cover the relationship between itching and specific mental health issues.

Itchy skin may also occur when you have kidney failure. Your doctor may call kidney failure end-stage kidney disease (ESKD). End-stage renal disease (ESRD) also refers to kidney failure.

Luckily, there are several treatment options for itchy skin when you have kidney disease. It is best to consult your doctor and the dialysis team when determining the best treatment plan. Maintaining good communication with your doctor may be necessary to improve comfort. Also, there may be new treatment methods that you may know about already.

Your doctor may also refer to pruritus as chronic kidney disease-associated pruritus (CKD-aP).

Signs of pruritus

Itchy skin may affect specific areas, such as the scalp, leg, or arm. It could also occur in the whole body. Every situation is unique. You may not notice any changes in the skin. Its symptoms could also include:

• Redness

• Scaly patches

• Dry, cracked skin

• Scratch marks

• Bumps, spots, or blisters

You may develop an itch-scratch cycle in some cases. Scratching an area may make it itchier. Breaking this cycle may be challenging.

When to see a doctor

It is best to see a doctor when the itching:

• Does not improve with various self-care measures

• Disrupts your routine severely, especially when you are unable to sleep well

• Affects your whole body

• Occurs suddenly

• Comes along with symptoms such as weight loss, night sweats, or fever

Your doctor may include a skin specialist (dermatologist) in your dialysis team. Monitoring itchy skin may help you to get the best results with itchy skin treatment.

How common is itching in chronic kidney disease?

Studies confirm that itching occurs in numerous patients with CKD. Patients with advanced kidney disease may experience the symptom more. You may also witness itchy skin when undergoing dialysis.

The cause of itching is often unclear. However, itchy skin can be made worse by the following:

• Hyperparathyroidism: Overactive parathyroid glands may overwork the kidney; the role of the kidney is to filter hormones from your blood.

• Anemia: The shortage of red blood cells can worsen CKD symptoms such as pruritus.

• Allergies: Allergies that cause the skin to be red could get worse when one has CKD.

• High aluminum or magnesium levels in the blood: These minerals could worsen the signs of CKD, such as itchy skin due to overworking the kidneys.

• High salt and phosphate levels in the body: It is best not to overwork the kidney when one has CKD.

• Eczema: It is a typical allergic reaction to specific factors in the environment. It may make the skin red and itchy. Your doctor can help you to determine the cause of the itchy skin.

• Diabetes: It is a long-term condition that affects how your body cells use glucose. This condition can make skin itch worse in a variety of ways. It may reduce your immunity,² making you prone to seasonal allergies if you have specific ones.

• Uraemia or high levels of urea in the blood: The presence of urea in high quantities when one has CKD may limit the effectiveness of the kidneys. The side effects may include the development of itchy skin.

• Hot weather: It may reduce the moisture on your skin, thus making it easy to crack. The resulting discomfort may increase the urge to scratch affected areas. Maintaining moisture on the skin can help you to avoid the problem. Wearing loose cotton may be an effective way to prevent dry skin in certain environments. Also, it is best to use specific lotions as directed by your doctor.

• Insufficientdialysis: Inadequate dialysis could result from issues such as failing to attend some sessions as directed by the doctor. It could accumulate toxic materials in the blood, thus straining the kidneys.

• Having a restricted fluid intake

• Certain morphine-based painkillers

• Dry skin

• Certain cleaning products or toiletries

How will itching affect me?

Itching is unique to everyone. It may be continuous or come and go as you attend dialysis. It could only affect parts of your body, such as the arms and legs, or the entire body. The itch may feel internal, like something crawling under the skin.

Itching may lead to fatigue when it occurs at night. It could reduce your sleep quality, making you less productive on some days. You may also experience mood changes due to poor sleep. Itching can affect your social life in cases where it makes you restless.³

Itching could affect the appearance of your skin; it can look dry and crack easily. The cracks may also bleed in some cases. Scratching may also expose you to higher infection risks since germs can easily reach your blood.

What stage of kidney disease causes itching?

Kidney disease is categorized into five stages based on its severity.

Itching is often associated with stages 4 and 5.⁴ However, depending on your body's reaction to factors such as treatment, it could occur at any stage. The American Academy of Dermatology⁵ notes that itchy skin may be common in later stages of CKD. It is best to consult a doctor since itchy skin is not the only indicator of advanced kidney disease.

How will I know if I have pruritus?

You can only determine if you have pruritus through your doctor. However, the signs above suggest that you could have pruritus if you have CKD.

How is pruritus treated?

You can ease itching by trying the following tips:

• Wear loose clothes made from natural fabrics such as cotton.

• Replace toiletries and cleaning products that irritate your skin.

• Keep your skin moisturized, especially in drier environments.

• Use unscented bath and shower products.

• Consider patting your skin when bathing instead of rubbing.

• Use skin products that are kind to the skin. Consulting your doctor may be necessary to improve your skin's preventative ability besides reducing the itch.

Itching may be challenging to treat. You can try several options before your team selects one. Your doctor may propose either of the following medicines if the above tips do not help.

• Gabapentin or pregabalin: These medications reduce itching by modifying how your nerves work. They may make you sleepy or dizzy.

• Sertraline: The drug is an antidepressant. It works by regulating how specific chemical messengers (serotonin) are reabsorbed in the brain. It may take some time for the medication to start working.

• Phosphate-binding medications: They lower phosphate levels in the blood. Their effectiveness is case relative. You should only use phosphate-binding medications with the approval of your doctor.

• Oral antihistamines: a healthcare professional may recommend them for skin itch despite their typical use in treating allergic reactions. It may be best to take antihistamines before bed since they may come along with fatigue. Thus, you should also avoid operating machinery when you use them.

• Korsuva: In 2021, the FDA approved Korsuva⁶ for treating moderate-to-severe itching for people with CKD and undergoing dialysis. The injection is administered after every dialysis session.

How do doctors treat pruritus?

Your dialysis team may do the following when treating itchy skin:

• Increase the number of dialysis sessions that you attend

• Propose changes that can relieve the urge to scratch your skin, such as using specific lotion

• Your doctor may test the levels of specific minerals in your blood, such as phosphorus, aluminum, magnesium, and parathyroid hormone. High levels of these minerals could make your doctor recommend kidney-friendly foods and drinks. Certain medications may contain high levels of the above minerals — your doctor may ask you to avoid them or reduce their intake. The aim is to retain mineral concentration at a healthy range depending on the state of your kidneys. The National Institute of Diabetes and Digestive and Kidney Diseases noted that high phosphorus levels⁷ in your blood sometimes cause itching.

• Give you allergy medication

• Prescribe certain medications:

  • The Food and Drug Administration specifies the medications used to treat pruritus based on its severity.

• You may be given the medications at the end of the dialysis session. Your doctor also considers the type of dialysis you undergo. Patients who do peritoneal dialysis can only be given some medications.

It is advisable to have a professional diagnosis before taking any medication.

How can I prevent pruritus?

The following tips can help you to reduce incidences of itchy skin when you have kidney disease:

• Consult your dialysis team early when you have itchy skin. Your doctor can help you identify the cause and solution of the itch.

• Taking medications as instructed may also reduce the chances of itching. Following your doctor's advice is essential in maintaining normal concentration levels for minerals such as phosphorus.

• Having a kidney-friendly eating plan and limiting phosphorus intake may be necessary.

• It is best to avoid scratching affected areas since that could worsen the itch.

• You can also change some home routines to include:

  • Selecting soaps that are friendly to your skin

  • Softening your skin with emollients or lotion

  • Take showers and bathe with warm water

  • Add moisture to your home with a humidifier

What other problems can pruritus cause?

Scratching itchy areas can cause problems such as:

• Making cuts on the skin. The issue could lead to loss of blood through bleeding. The exposed cuts may also facilitate the entry of germs into the body.

• It can make the itch worse.

Does pruritus affect mental health?

Living with itchy skin for weeks or even months could significantly affect your mental and emotional well-being. You may experience a constant urge to scratch the itching areas. The distress can:

• Restrict you as you undertake daily activities

• Affect your mood by distracting your sleep

• Make you more self-conscious in a negative way. You may be worried by the discolored patches on your skin.

• Make you more stressed given that it is an addition to having kidney disease.

It is best for the treatment plan to include mental care, given that prolonged distress could lead to anxiety and depression — among other mental health issues. Attending counseling sessions is wise when you realize that itchy skin affects your mental well-being.

Fortunately, you are not alone. There are enough resources for you to cope well. Social workers, for instance, can help you connect with CKD support groups.

What helps with itching from kidney disease?

You may find relief from the following guidelines for itch treatment and prevention besides specific treatment for CKD-aP. You can try the following when you have a flare-up:

• Using a cooling agent on the affected areas. Consult your doctor when selecting the agents to use.

• Apply a layer of (fragrance-free) moisturizer.

• Placing a wet cloth or an ice pack over the affected area could also help.

• An oatmeal bath may also soothe you.

You can also try the following preventive measures to reduce itchy skin:

• It may be best to shower using lukewarm water.

• It is best to select products you use on the skin carefully. Using fragrance-free ones may be best.

• Loose-fitting cotton clothing may also make you comfortable.

• Avoiding dry environments may also help.

The lowdown

Chronic kidney disease (CKD) is the gradual reduction in the functioning of the kidneys. It is classified into different stages depending on the severity, with stage 5 being the most severe.

Pruritus refers to itchy skin that may occur in patients with CKD. The condition may involve skin redness, a constant urge to scratch, and possible cuts. While there are several treatment options for pruritus, a doctor is best qualified to recommend one, depending on your CKD state.

The cause of itchy skin is judged on a case basis. It may occur during dialysis sometimes. In some cases, it could be due to an increase in the body's phosphorus.

The illness may be treated using FDA-approved medications such as Korsuva. Itchy skin in CKD patients may also be treated using antihistamines.

The effectiveness of antihistamines may be limited since the itch is not a typical allergic reaction. Therefore, it is best to seek your doctor's approval before taking any medication.

Pruritus has many causes. Higher phosphorus levels in the blood, for example, could overwork your kidney.

Studies indicate the importance of maintaining minerals such as magnesium and calcium within specific ranges when you have CKD. Thus, your doctor can advise you to avoid particular foods and medications for the best results.

It is best to maintain effective communication with your doctor during treatment. Your dialysis team can include a dermatologist in some cases. Your doctor will help you make an effective treatment plan despite several feasible therapeutic interventions.