Pruritus (itchy skin) and kidney disease
Pruritus means itchy skin. For people living with kidney disease, this itching can feel constant, severe and very different from everyday dry skin. It can affect your sleep, your mood and quality of life. The good news is there are steps you can take to get relief.
What is pruritus?
Pruritus is ongoing, often severe itching. It isn’t a disease on its own but a symptom of another condition. When itching is caused by chronic kidney disease (CKD), it is called uremic pruritus. This is a common and often uncomfortable problem that creates a constant urge to scratch. The sensation can be severe, sometimes even painful. Pruritus is most common in people with kidney failure, also known as end-stage kidney disease (ESKD) or end-stage renal disease (ESRD) but can also happen in early stages of CKD.
How pruritus differs from regular itching
Regular itching usually happens because of something on the surface of the skin, like dry skin, a bug bite or an allergic reaction. It often improves if you scratch, use lotion or take allergy medicine. But kidney-related pruritus is different.
With pruritus, the itch comes from inside the body, not just the skin. The itch also tends to be more widespread (not just in one spot), longer lasting, and more intense, especially for people who are on dialysis.
Unlike regular itching, kidney-related pruritus:
- Often can feel like crawling, prickling or stinging under the skin
- May not improve with scratching, and scratching can sometimes make it worse
- Can feel deep, as if the itch is coming from inside the body, not just the skin's surface
- May come and go, or last for weeks, months, or even years
Almost half of people on dialysis have moderate to severe pruritus.
Other signs include:
- Redness or inflammation on the skin
- Scratch marks or raw skin from scratching
- Bumps, spots, or blisters
- Dry, scaly, or cracked skin
If you have pruritus, itching may feel worse at night. This can happen because your body temperature rises, your skin loses more moisture, and your natural anti-inflammatory hormones are lower while you sleep. It's important to remember that the skin might look completely normal even if you have an intense itch. Visit your doctor if the itching is severe or doesn't go away.
Where does the itching happen?
Itching from kidney disease doesn’t always feel the same for everyone. Some people notice it in just one area at first, while others feel it all over. Itching may start in one spot, like your back, but often spreads.
Common areas include:
- Back (often where itching starts)
- Arms and shoulders
- Head and face, including the scalp
- Chest and stomach
- Sometimes the whole body
Itching often happens on both sides of the body at the same time (for example, both arms or both legs). Itching is most common and severe in people with kidney failure,but those in the earlier stages of CKD may also notice milder itching.
What causes pruritus?
Doctors do not fully understand what causes kidney-related itching, but some believe it may be due to:
- Waste building up in the body from not getting enough dialysis
- Long-term inflammation (swelling) in your body
- Dry skin, often caused by loss of sweat glands, a common problem in people on dialysis
- High levels of phosphorus (hyperphosphatemia)
- High levels of parathyroid hormone (hyperparathyroidism)
- High levels of magnesium, calcium and aluminum
- Nerve damage
How do doctors treat pruritus?
To treat pruritus, your doctor or dialysis care team may:
- Increase the amount of dialysis you get to filter the blood of toxins
- Suggest using a special type of lotion or cream every day
- Suggest a kidney-friendly eating plan that limits food and drinks that are high in phosphorus
- Suggest antihistamines (medicines that treat allergies)
- Prescribe other medicines to help keep your phosphorus, magnesium, aluminum and hormone levels in a healthy range
The Food and Drug Administration (FDA) has approved an injection called difelikefalin, the first prescription treatment for treating moderate to severe pruritus in adults on hemodialysis. (Note, this is not recommended for people who do peritoneal dialysis.)
Talk with your doctor if you feel itchy, even if you have asked them about it before or tried treatments that have not worked in the past. There are many ways to treat pruritus.
How can I treat or prevent pruritus at home?
While it's important to see a doctor for a proper diagnosis, you can do several things at home to help manage the itch:
For quick relief:
- Apply fragrance-free moisturizer or creams when your skin feels dry
- Apply a cool compress or take a short cool shower to soothe the itch
- Relaxation techniques like deep breathing or meditation to calm the urge to scratch
- Avoid scratching, which can break the skin and cause infection
As part of your daily routine:
- Take your medicines as prescribed
- Follow a kidney-friendly eating plan, limiting foods high in phosphorus
- Use gentle soaps and detergents made for sensitive skin
- Moisturize daily, even if your skin doesn't feel dry
- Bathe or shower in cool or warm (not hot) water
- Use a humidifier to keep indoor air moist
- Wear loose, breathable clothing to reduce irritation
View our pruritus webinar
Itchy skin and kidney disease
In this webinar, nephrologist Dr. Shayan Shirazian discusses what experts know about pruritus and how to manage it in your daily life.
What other health problems can pruritus cause?
Pruritus is more than just uncomfortable. If it continues, it can lead to other health problems, including issues caused by scratching.
Ongoing scratching can cause:
- Bleeding
- Skin infections
- More irritation, leading to a cycle of scratching and itching
How does pruritus affect mental health?
Constant itching can take a toll on your mind and emotions. It may cause:
- Anxiety and stress: Pruritus can flare up at any time, making you feel worried and stressed.
- Depression: Frustration and sleeplessness can lead to hopelessness and sadness.
- Social withdrawal: Feeling self-conscious about the appearance of your skin or the constant need to scratch can make you want to avoid social activities.
- Reduced quality of life: Pruritus can affect your ability to work, socialize and enjoy daily activities.
You are not alone
Many people with kidney disease have pruritus and there are professionals and resources to help you cope in healthy ways. For example, social workers can connect you with kidney disease support groups and other resources in your community.
Talk with your doctor
Pruritus is common in kidney disease, but it is treatable. Tell your doctor and care team how often you itch and how it affects your daily life. This guide can help you make a plan with your doctor to treat or prevent pruritus.