The Kidney-Related Itch That Can’t Be Scratched…All About Uremic Pruritis

Along with kidney issues, come a litany of related issues due to toxin build-up within the body and the fact that impaired kidney function typically means those trapped toxins just keep accumulating over time. The body, only able to take so much, will typically use whatever organs it can to try to minimize the toxic load. This can often lead kidney sufferers to develop a condition known as uremic pruritus.

What is uremic pruritus?
Uremic pruritus, also known as, CKD-associated pruritus. This skin condition occurs when excessive urea builds up in the blood. It typically manifests as extremely itchy skin. It’s more common among dialysis patients, occurring in nearly a third of them and is more commonly found in those patients receiving hemodialysis than in those receiving continuous ambulatory peritoneal dialysis.  

What are the signs and symptoms of uremic pruritus?

Uremic pruritus is characterized by nearly daily itching bouts, worsening nightly and making sleep very difficult. Itches could be localized in only one area or generalized, but the areas of the body most often affected include the back, stomach, arms and/or head. In those receiving dialysis, pruritus attacks are typically of lower intensity immediately following dialysis but peak in severity around two days later. Skin areas suffering from pruritus will usually (but not always) appear dry with patches of picked sores and scratch marks.

Potential complications of uremic pruritus?

  • Impetigo (skin infection)


  • Prurigo (papules)


  • Dermatitis


  • Eczema


  • Increased mortality (as much as 17%)



What is the cause of uremic pruritus?

Although we aren’t entirely certain what causes uremic pruritus, there are many factors which, when combined, can influence the probability one has of developing uremic pruritus. These include:

  • Habitually dry skin 


  • Reduced sweating


  • Abnormal metabolism of calcium and phosphorus / raised parathyroid hormone


  • Toxin accumulation


  • Sprouting of new nerves


  • Systemic inflammation


  • Co-existing conditions like liver disease and diabetes


Treatment Methods

Treatment options typically revolve around optimizing the efficacy of your dialysis sessions. Reducing serum parathyroid hormone can be a great way to normalize phosphorus and parathyroid levels which can also provide relief.

Addressing dry skin by using non-soap cleansers, applying emollient-rich creams containing sorbolene, petrolatum, menthol/camphor or capsaicin throughout the day may also help. Although oral antihistamine and steroids don’t really provide benefit, UVB phototherapy is a mainstay of treatment that has been shown to be effective along with select prescriptions like Gabapentin and Pregabalin.  For more information on what you can do to treat symptoms associated with kidney issues, be sure to check out the Healthy Kidney Inc. YouTube, updated daily.