Uremic pruritus

Chronic itch (CI) is a frequent and often tormenting symptom in patients with advanced chronic kidney diseases. The skin of affected patients often shows no obvious alterations but as a sequel to scratching secondary skin lesions, such as excoriations, scars and prurigo nodularis then develop. Because of the lack of knowledge on the pathogenesis and the low number of valid clinical trials, the treatment of CI is difficult and mostly symptomatic. Almost all drugs used for treatment of pruritus are not approved for this indication in Germany. The centrally acting calcium channel blockers gabapentin and pregabalin have been shown to be effective for CI and UVB phototherapy has also been proven to provide relief from pruritus in many patients. Recent randomized controlled studies have shown that nalfurafine, a kappa opioid receptor agonist, can effectively relieve pruritus in patients but is not currently approved in Europe. For naltrexone, a µ‑opioid receptor antagonist, contradictory results have been reported for CI in hemodialysis patients. © 2016, Springer-Verlag Berlin Heidelberg.