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Itching of the skin with a desire to scratch (also called uraemic pruritus) is common in people with advanced chronic kidney disease (CKD). It can be a serious problem for many people and can have a major effect on your quality of life.
How common is itching?
Itching is very common. It affects around half of people with advanced kidney disease and almost everyone with kidney failure who is receiving dialysis or conservative care. You may find that you get itchier as your kidney function gets worse.
The precise cause for itching in kidney disease remains unclear but a number of factors may be involved.
Itching might be caused or made worse by:
- Dry skin
- Hot weather
- Certain toiletries or cleaning products
- Not enough dialysis
- Having overactive parathryoid glands (Hyperparathyroidism)
- High magnesium or aluminium levels in the blood
- Uraemia - high levels of urea in the blood
- Higher levels of Phosphate
- Anaemia - shortage of red blood cells
- Iron deficiency - low iron levels in the blood
- Certain medicines such as morphine-based pain killers
- Being on a restricted fluid intake
How will itching affect me?
Itching affects people in different ways. It can come and go or it may be continuous. It may affect your whole body or be limited to a specific area – usually your back or arms. Itching tends to affects both sides of the body at the same time and may feel internal, like a crawling feeling just below the skin.
You are more likely to be itchy at night, which can affect your sleep and make you tired the next day. This can affect your mood. In severe cases, itching can affect your social life due to severe irritation and restlessness.
Itching can affect how your skin looks. It may be dry and crack easily, which can cause bleeding. You may see marks or cuts where you have scratched and this can increase the risk of infection.
How is itching treated?
Itching can be eased by:
- Wearing loose, non-irritating clothing made of natural fabrics e.g. cotton
- Changing your toiletries or cleaning products
- Avoiding particularly dry environments
- Avoiding wearing perfumes or aftershave
- Using unscented shower and bath products
- Patting rather than rubbing your skin dry after a bath or shower
- Using an unscented moisturiser on dry areas of skin, particularly one containing menthol or aloe vera. This should be used every day, not just when you are itching, in order to maintain the skin's barrier prevention. Your pharmacist can advise on suitable products.
Are there any other options?
Itching can be difficult to treat and you may need to try different treatments before you find one that works for you. If the above suggestions haven't helped, you can talk to your doctor about possible medicines including:
Gabapentin or pregabalin: These medicines can reduce itching by affecting how your nerves work. They can also make you sleepy and dizzy and the dose must be carefully monitored.
Sertraline: This is a type of anti-depressant called a selective serotonin reuptake inhibitor (SSRI). It may reduce your itching but can take a while to have an effect.
Phosphate binding medications: These medications lower your blood phosphate levels. However, it is debatable whether they help with itching. If your doctor has advised you that you need these then you should continue their use.
Oral antihistamines: These are often tried for itching. However, the mechanism of itching associated with kidney disease is different from allergic itching and so antihistamines are usually not effective. Antihistamines can make you feel tired so if you do try them, it is best to take them before you do to bed to help you sleep. You should avoid using them if you are planning to drive or use machinery.
Some of the medicines above are not licensed for use for itching and it is important to discuss this with your doctor before trying them.
You should always follow your healthcare team’s advice regarding medications.
You may be referred to a specialist skin doctor (dermatologist). They can help to identify any other conditions that may be causing your itching but are not related to your kidney disease.
If itching becomes a major problem, you may decide to seek psychological support as there are tools available which can help you to manage, such as breathing techniques and mindfulness. Even if your itching is worse after dialysis you should always stick to the dialysis schedule advised by your doctor.
If you receive a kidney transplant, the itching associated with your kidney disease will go away.