Pruritus in Chronic Kidney Disease

Nupur N. Uppal; Antonio Corona; Steven Fishbane


Curr Opin Nephrol Hypertens. 2022;31(5):435-441. 

In This Article


Diseases of the nerves that innervate the skin may also contribute to CKD-aP. Since sensory nerve endings in the skin are the normal pathway for detecting itch, it follows that dysfunction of these nerves can result in pathologic itch. Various neurotransmitters are implicated in the activation of pruriception in the epidermis, including serotonin, calcitonin gene-related peptide, opioid peptides, histamine and other cytokines. However, in uremia, systemic inflammation, endothelial dysfunction, and uremic toxin retention have been proposed to cause neurodegeneration and resultant nerve dysfunction.[19] These mechanisms can result in both neuropathic pain and pathologic itching.[20] When considering the nervous system and its relation to CKD-aP, the fact that drugs with an inhibitory effect on neurotransmission provide relief for pruritus is ex juvantibus evidence for the role of neuropathy in CKD-aP.[16]