• Common abnormalities in ESRD play a role in pathogenesis:
    • Xerosis (dry skin)
    • Peripheral neuropathy
    • Hypercalcemia
    • Hyperphosphatemia
    • Hypermagnesemia
    • Zinc depletion
    • Hypervitaminosis A
  • No correlation found between standard biochemical tests (blood urea nitrogen, creatinine, calcium, phosphate, parathyroid hormone) and uremic pruritus2
  • A possible role for chronic inflammation3
  • A possible relationship between pruritus and type of dialyzer is not clear4

Treatment 5-8

  • Empirical, individualized and often ineffective
  • Skin emollients, capsaicin, H-1 receptor antagonist, phototherapy (UVB)
  • Newer drugs: Thalidomide, nicergoline, lidocain, mexiletine, cholestyramine, cromolyn sodium and Gabapentin
  • Other modalities: Acupuncture, electric needle stimulation and sauna, parathyroidectomy and renal transplantation in recalcitrant cases


  • Optimizing calcium, phosphate, magnesium, PTH and delivered dose of dialysis (greatly reduced at Kt/V > 1.59)
  • Avoidance of dialysis related factors10 such as iodine, ethylene oxide.  Find out any allergy to heparin.
  • Biocompatible membrane can be used preferably
  • Consider parathyroidectomy. Renal transplantation is the only definitive treatment.


  1. Lugon JR.  Uremic pruritus:  A review. Hemodial Int 9:180-188, 2005
  2. Virga G, Mastrosimone S, Amici G, Munaretto G, Gastaldon F, Bonadonna A. Symptoms in hemodialysis patients and their relationship biochemical and demographic parameters. Int J Artif Organs 21:788-793, 1998
  3. Kimmel M, Alscher DM, Dunst R, Braun N, Machleidt C, Kiefer T, Stulten C, van der KH, Pauli-Magnus C, Raub U, Kuhlmann U, Mettang T. The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients. Nephrol Dial Transplant 21:749-755, 2006
  4. Rollino C, Goitre M, Piccoli G, Puiatti P, Martina G, Formica M, Quarello F, Bernengo MG. What is the role of sensitization in uremic pruritus? Nephron 57: 319-322, 1991
  5. Schwartz IF, Iaina A. Management of uremic pruritus. Semin Dial  13:177-180, 2000
  6. Urbonas A, Schwartz RA, Szepietowski JC. Uremic pruritus-an update. Am J Nephrol  21:343-350, 2001
  7. Rosner MH. Cromolyn sodium: A potential therapy for uremic pruritus? Hemodial Int 10:189-192, 2006
  8. Manenti L, Vaglio A. Gabapentin for uraemic pruritus
    232. Nephrol Dial Transplant 20:1278-1279, 2005
  9. Masi CM, Cohen EP. Dialysis efficacy and itching in renal failure. Nephron  62: 257-261, 1992
  10. Kessler M, Moneret-Vautrin DA, Cao-Huu T, Mariot A, Chanliau J. Dialysis pruritus and sensitization. Nephron  60:241-251, 1992