Pruritus (itchy skin)
Understand what chronic kidney disease-associated pruritus (also called uremic pruritus) is, what causes it and how to talk with your doctor about treatment.
Pruritus is distressing, itchy skin. The itchy feeling can be so constant and uncomfortable that it may disrupt your sleep and affect your mental health and overall quality of life. It can be especially severe and troubling in people who are in kidney failure, also called end-stage kidney disease (ESKD) or end-stage renal disease (ESRD). Pruritus is more common in people who are on dialysis. There are several ways to treat pruritus. Talk with your doctor or others on your dialysis care team about the treatment option that is right for you even if you have asked them in the past. There are new treatments available.
What is pruritus?
Pruritus is distressing, itchy skin, which creates a prickly feeling on or under your skin and an urge to scratch it. It is also called uremic pruritus or chronic kidney disease-associated pruritus (CKD-aP). Constant itching may lead you to have scratch marks on your skin or patches of irritated skin. Sometimes, the itchy patches of skin may be red or a different color than your usual skin tone. Other times, there is no change in color to your skin. Pruritus commonly appears on the skin on your back, arms, head or belly (abdomen).
What causes pruritus?
Doctors do not fully understand what causes pruritus in people on dialysis, but some people have:
- Not received enough dialysis
- Long-term inflammation (swelling) in your body
- Dry skin, often caused by loss of sweat glands which is a common problem in people on dialysis
- High levels of phosphorus (hyperphosphatemia)
- High levels of parathyroid hormone (hyperparathyroidism)
- High levels of magnesium and aluminum
There are also other causes of pruritus in people living with kidney disease, so it is important to work with your doctor to learn more about the cause of your symptoms.
How will I know if I have pruritus?
Symptoms of pruritus may be different for you than for others, but often include:
- An itchy feeling of uncomfortable prickling or crawling under your skin that:
- May always be there or may come and go
- Creates an urge to scratch but is not relieved by scratching
- Is most common on your back, but may also be on your arms, head, belly (abdomen) or sometimes all over your body
- Patches of skin that are itchy, raw, dry or a different color than your usual skin tone
The itching can happen at any time but may be worse:
- At night, which can cause poor sleep
- In hot weather
- When you feel stressed
How do doctors treat pruritus?
To treat pruritus, your doctor or dialysis care team may:
- Increase the amount of dialysis you get
- Ask you to make changes at home to help your skin and relieve the urge to scratch, such as using a special type of lotion every day
- Test the levels of calcium, phosphorus, magnesium, aluminum and parathyroid hormone in your blood — if any are high, your doctor may prescribe a kidney-friendly eating plan that limits foods and drinks with phosphorus and medicine to help keep levels in a healthy range.
- Have you take an antihistamine (medicines that treat allergies), which may make you drowsy
- Prescribe other medicines
- The Food and Drug Administration (FDA) approved the first prescription treatment for treating moderate to severe pruritus in adults getting hemodialysis
- The medicine is added to your dialysis treatment at the end of each in-center hemodialysis session — it 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?
To help treat or prevent pruritus:
- Talk with your doctor or any member of your dialysis care team if you have any itchy skin. Ask about new treatments you may qualify for.
- Take any medicines as instructed
- Follow a kidney-friendly eating plan and limit foods that have phosphorus
- Make changes in your home routines, such as to:
- Switch to soaps and laundry detergents made for sensitive skin
- Use lotion or emollients to moisturize and soften your skin every day
- Take baths or showers in cool or warm water, not hot water
- Use a humidifier to add moisture to the air in your house
- Avoid scratching at itchy skin, which can make the itch worse, damage your skin or make it infected
What other health problems can pruritus cause?
Scratching the itchy areas can cause other skin problems, including to:
- Make the itching worse
- Make cuts or marks on your skin, which can lead to bleeding and infection
How does pruritus affect mental health?
Living with pruritus for weeks, months or years can take a toll on your mental and emotional health. The constant prickling of itchy skin and the urge to scratch can be distressing and can:
- Bother or distract you during your day
- Disrupt your sleep, which can affect your mood
- Make you self-conscious about how the irritated or discolored areas of your skin look to others
- Add to the stress of having kidney disease
Over time, the distress of having pruritus can lead to feelings of anxiety, depression and other mental health issues. In people with ESKD or ESRD, it can even raise the chance of dying sooner.
The good news is that you are not alone. There are people 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.
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.
Talk with your doctor about treating pruritus (itchy skin)
Pruritus is distressing, itchy skin, which is common in people on dialysis. Download our guide to help you make a plan with your doctor to treat or prevent pruritus.