Pruritus associated with chronic kidney disease withand without renal replacement therapy.

Abstract

Introduction: Pruritus associated with chronic kidney disease (CKD) affects quality of life adherence to treatment and increases mortality in patients with chronic kidney disease with and without extracorporeal renal replacement therapy (hemodialysis or peritoneal dialysis). Its prevalence and intensity of symptoms are higher in peritoneal dialysis (PD) than in hemodialysis (HD). The diagnosis is made using scores that avoid subdiagnosis. Its
treatment is related to the intensity of the symptoms, from mild to moderate, topical treatment, and, in severe
symptoms, systemic. It usually presents as large, symmetrical, reddened areas of skin, often at night.

Objective of the review: The aim is to review the main pathophysiological aspects and establish an algorithm
for diagnosing and treating pruritus in patients with chronic kidney disease with and without requiring renal
replacement therapy (hemodialysis and peritoneal dialysis).

Essential points of the review: There are several diagnostic scores, such as the visual analog scale, that
measures the intensity of itching, the Pauli-Magnus scale that relates to the quality of sleep, and the 5-D itching
scale that evaluates the quality of life; however, the KDQoL-36, WINRS, and SADS are more practical at the time of assessment. The most recent treatment is Nalfurafine, a k-opioid receptor agonist, which has reduced the severity of symptoms by 95%.

Conclusion: The objective of the review is to review the main pathophysiological aspects and establish an algorithm for diagnosing and treating pruritus in patients with chronic kidney disease with and without requiring renal replacement therapy (hemodialysis and peritoneal dialysis).