A review of the management of uremic pruritus: current perspectives and future directions

Abstract

Uremic pruritus (UP) is a common and distressing symptom experienced by up to half of all patients with end-stage renal disease (ESRD) receiving dialysis. It is associated with multiple health-related quality of life impairments and has been independently associated with mortality. Despite the prevalence and associated impact on quality of life, UP remains a difficult symptom to treat because of the relative lack of existing high quality evidence on which to base recommendations and the sheer volume of poorly studied therapeutic options. This review outlines the existing data of available treatment options including topical therapy, systemic therapy, and phototherapy as well as explore emerging data on therapies that are targeting novel pruritus pathways including the cannabinoid and opioid pathways. Overall, neuromodulators, in particular gabapentin, appear to have the most robust data in the treatment of UP. In individuals who cannot tolerate oral systemic therapy or in those with refractory generalized UP, ultraviolet phototherapy, specifically broad-band UVB, has shown significant promise. However, access is often a limiting factor. Lastly, the emergence of new therapies targeting a peripheral acting κ-opioid agonist, difelikefalin, has demonstrated effect in both early phase 2 and 3 clinical trials.