Hemodialysis 101 | How Kidney Patients Can Cope with Unbearable Skin Itching

In chronic kidney disease (CKD), especially among patients with end-stage renal disease, uremic pruritus is a common complication, with an incidence rate of 28% to 70%. The incidence rate among hemodialysis patients can be as high as 50%.

Itching commonly occurs on the head, neck, back, hands, and lower limbs, typically exhibiting bilateral symmetry and being more pronounced at night. Severe skin itching can lead to a decline in patients' quality of life, sleep disturbances, depressive states, and increased mortality rates, severely affecting patients.

1. What Causes Itching?

Research suggests that the mechanism of itching may involve the complex interaction of uremic toxins, systemic inflammation, mast cell activation, and opioid receptor imbalances. The main causes are as follows:

A. Metabolic Disorders Leading to Accumulation of Various Toxins in the Body (Parathyroid hormone, histamine, tryptase, exogenous substances, aluminum, magnesium, calcium, phosphorus, cytokines, and inflammatory factors)

For example: Hypocalcemia can easily induce hyperparathyroidism, causing elevated parathyroid hormone levels. This leads to increased deposition of calcium salts in skin tissues, stimulating mast cells to release large amounts of histamine, resulting in skin itching. The higher the parathyroid hormone level, the more severe the itching.

B. Central Nervous System Disorders (Opioid receptor imbalances, psychological factors)

For example: Complications such as skin itching can directly cause negative emotions like anxiety, irritability, and depression in patients. Emotional fluctuations can prompt the skin to release large amounts of neurotransmitters, exacerbating skin itching.

C. Local Skin Conditions (Dryness, dermatitis)

Hemodialysis patients often experience dry skin due to reduced skin lipid content and dehydration. Dry skin is more prone to itching. In elderly patients, the decline in skin barrier function and increased water loss with age further aggravate skin dryness.

D. Peripheral Nervous System Disorders (Abnormal peripheral receptors, sensory-motor nerve or autonomic nerve disorders)

E. Immune System Disorders (Skin microinflammation, allergies)

Skin microinflammation and systemic inflammation may stimulate itching. Previous studies have found that high C-reactive protein levels are positively correlated with the occurrence of itching, and the severity of skin itching in hemodialysis patients increases with higher C-reactive protein levels.

Skin itching has a complex pathogenesis and is a subjective symptom closely related to patient tolerance, mental state, disease status, and medication use.

2. How to Improve Patient Itching

A. Improve Dialysis Quality

A controlled trial of high-flux versus low-flux hemodialysis showed that the incidence of itching was significantly lower in the high-flux group (10%) compared to the low-flux group (26.7%).

Using different combinations of hemodialysis methods adjusts calcium and phosphorus metabolism in patients and significantly improves uremic itching. Thus, high-flux dialysis or combined treatments can effectively alleviate itching.

B. Systemic Drug Therapy

Calcium Channel Modulators: Gabapentin and pregabalin have been shown to be effective for uremic pruritus.

Opioids: Opioid receptor agonists or antagonists provide new treatment options for pruritus in dialysis patients.

Sodium Thiosulfate: Has nonspecific anti-allergic and anti-itch effects and is more effective for refractory pruritus when combined with hemoperfusion.

Antihistamines: With few side effects and high safety, they are the first-line medication for many clinicians treating itching.

Antidepressants: Patients with pruritus are more prone to depression, which can exacerbate the sensation of itching.

C. Moisturizing Care

Avoid using strong alkaline soaps or shower gels during bathing, and keep the water temperature between 37–40°C.

Regularly apply moisturizers like petroleum jelly, glycerin, or vitamin E.

For patients with noticeable scratches and eczema, provide proper skin care, such as wearing gloves and getting adequate sun exposure to reduce calcium, phosphorus, and magnesium content in the skin through UV exposure.

D. Combined Traditional Chinese Medicine Treatment

Techniques like acupuncture, ear acupressure, herbal baths, and herbal compresses can all help alleviate pruritus symptoms. Combining traditional Chinese medicine with other treatments can effectively enhance treatment outcomes.

This introduction covers the current status, causes, and treatment methods for pruritus. We hope it helps kidney patients.

In the next issue, we will cover Restless Leg Syndrome. We welcome kidney patients to bookmark, follow, and share. If you have other suggestions or topics of interest, feel free to leave us a message.

Let’s continue to learn more about hemodialysis in the next issue!

References:

1. Dou Junkai et al. Meta-analysis of the efficacy of high-flux hemodialysis and hemodiafiltration in uremic pruritus. Journal of Mudanjiang Medical University, 2021, 42(05), 61-64+70.

2. Liu Jingmin. Analysis of the causes of skin itching in chronic renal failure hemodialysis patients. World Latest Medical Information Digest, 2016, 16(12), 163.

3. Su Rui et al. Clinical effect of nursing intervention in the treatment of uremic patients with pruritus undergoing hemodiafiltration. Clinical Research, 2023, 31(07), 180-183.

4. Yang Xing et al. Current treatment status and future prospects for CKD-associated pruritus. Practical Clinical Medicine, 2023, 27(06), 141-144+148.

5. Duan Xueping et al. Related factors of uremic pruritus in maintenance hemodialysis patients. Western Medicine, 2023, 35(02), 232-237.

6. Mettang T, Kremer A E. Uremic pruritus[J]. Kidney international, 2015, 87(4): 685-691.

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