Answer: Itching is a common complaint of patients with kidney disease. Among those requiring dialysis, 40-90 percent experience this symptom. The cause is unknown, but it is likely due to a combination of factors as indicated by the variability in symptoms and response to therapy. Possible contributing agents include dry skin, high blood levels of vitamin A, calcium, phosphorus, parathyroid hormone, beta2-microglobin and increased histamine levels in the skin. Additionally, other disorders such as the underlying cause of the patient's renal failure, allergies, gallbladder disease and cancers may be the source of itching in persons with kidney disease.

The onset, course and response to treatment are variable. While a majority of patients first experience this symptom after the initiation of dialysis, some patients may begin to itch before reaching end-stage renal disease (ESRD). Itching occurs equally often among patients dialyzing by hemodialysis or peritoneal dialysis (PD). The itching may be localized to one area of the body or generalized. The itching may be constant or intermittent. 

Furthermore, the intensity of the itching may vary with the timing of dialysis, with some patients typically experiencing the itching just before dialysis and others itching after the dialysis treatment. Management of this side effect of kidney disease is difficult. It is unknown whether increasing the dialysis dose improves symptoms, however, some patients who experience itching before starting dialysis may have discontinuation of their symptoms once dialysis has begun. Unfortunately, skin moisturizers and antihistamines are of limited benefit.

Nevertheless, a trial of these agents is necessary because they are easy to use and cause few side effects. Other therapies that may be helpful include oatmeal soaks, topical capsaicin, parathyroidectomy, binding agents such as oral activated charcoal and cholestyramine, odansetron and naltrexone. UVB phototherapy results in relief of symptoms for one to six months in as many as 90 percent of patients who receive eight exposures. A successful renal transplant is also a remedy.

Answer provided by Carolyn Cacho, MD, who serves as a member of AAKP's Medical Advisory Board. Dr. Cacho is an Assistant Professor of Medicine in the Division of Medicine at Case Western Reserve University School of Medicine.

The Dear Doctor column provides readers with an opportunity to submit renal related health questions to healthcare professionals who specialize in the area of concern. The answers are not to be construed as a diagnosis and therefore, altercations in current healthcare should not occur until the patient's physician is consulted.

This article originally appeared in aakpRENALIFE, July 2003 Volume 19 Number 1. 

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