Kidney ailments are risky illnesses that lead to life-threatening consequences. At least less than 10% of the world’s general population is diagnosed with chronic kidney disease. Signs and symptoms of kidney disease show up in different forms.

Itching is a common sign of an underlying kidney ailment but where do you itch when you have kidney disease? In this article, we will delve deep into this question and figure out ways to understand this condition.

1. What Causes Itchiness when You Have a Kidney Disease?

1.1 Pruritus

Pruritus is a general term used by the medical fraternity to refer to extremely itchy skin. Pruritus can be generalized or localized. It can be a symptom of a particular disease or may occur independently.

1.2 What Could Be the Possible Causes of Pruritus?

• Chronic kidney disease, in which case it is known as chronic kidney disease-associated pruritus.
• Local inflammation in the body
• Hyperphosphatemia is a high level of phosphorus in the body.
• An increased amount of trace elements like aluminium and magnesium.
• Shrinking of sweat glands in hemodialysis patients leaves them with dehydrated skin and thus, itchy skin.

Further ahead, we will delve into the relationship between pruritis and Kidney disease

2. What Is Chronic Kidney Disease?

A kidney functions to remove waste and toxins from the blood to maintain a person’s health. However,  a diseased kidney is one which is unable to filter the blood properly, producing signs in the body which indicate their malfunctioning. Chronic kidney disease is the most common kidney disease. Kidney disease affects at least 37 million Americans, but alarmingly only 10% of people are aware of their condition.

3. What Could Be the Warning Signs of Chronic Kidney Disease?

• Calcium deposits underneath the skin which appear as raised patches on the skin.
• Problems in urinating
• Fatigue
• Nausea
• Itchy skin
• Rashes on the skin

4. Where Do You Itch With Kidney Disease?

People with chronic kidney disease mostly have itchy skin throughout the body. But where do you itch with kidney disease? What can start the itch? A light physical touch can be a cause for starting the sensation of itching. The sites of the body that usually seem to be affected are:

• Face
• Arms
• Back
• Legs

5. What Is Chronic Kidney Disease Associated Pruritus (CKD-aP)?

As discussed earlier, pruritus is itchy skin which can be associated with chronic diseases like chronic kidney disease. Due to the damaged kidneys, a build-up of toxins and waste products in the blood occurs, known as uremia, which can cause itching. Thus, it is also known as uremic pruritus.

It is a common symptom of advanced kidney disease.

The exact cause of itchy skin seen in advanced chronic kidney disease is not known. Probable reasons are:

• An increased amount of phosphorus and magnesium in the blood could be the reason.
• A build of a specific type of waste product in the blood, referred to as uremia.
• A high amount of a hormone called parathyroid (hyperparathyroidism)
• A theory referred to as the opioid theory, in which the opioid receptors are distributed along the brain and spinal cord. It is speculated nerve signals sent to these receptors may be hampered which results in itchy skin.
• Nerve damage due to chronic kidney disease and end-stage kidney disease
• There is an immune theory that states that the body might attack its own nerve cells which may lead to itching.

6. At What Stage of Kidney Disease Does Pruritus Occur?

No disease occurs full-blown from day one, it creeps up on us. Kidney disease has been classified by experts into 5 stages, the last stage being kidney failure. People normally experience itching in advanced chronic kidney disease.

However, it is now also being recognized in mild forms of kidney disease as well.

7. How Is Chronic Kidney Disease Associated with Pruritus Manifest?

There are different ways in which chronic kidney disease-associated pruritus can present.

7.1 Parts of the Body

It might affect one side of the body or sometimes a particular site may be affected than the others. At times both sides of the body may be involved. Chronic kidney disease-associated pruritus is known to affect the face, arms and back the most.

7.2 Skin Diseases

Sometimes in addition to itchy skin, it may also present with other skin patches and infections of the skin. The skin may also develop blisters and rashes. A careful skin exam can also reveal the cause of itching

7.3 People on Kidney Dialysis

Haemodialysis patients with symptoms of itching should be investigated for CKD-aP as they are prone to the risk. The blood work is also studied by the doctors to understand if the ongoing dialysis is effective or if anything needs to be changed.

Other diseases like liver disease or infections are often ruled out by doctors to diagnose the itchy skin as CKD-aP.

8. How Uncomfortable Is CKD-aP?

Chronic kidney disease-associated pruritus (CKD-ap) or uremic pruritus is a condition which can be so severe that getting a night’s sleep may become impossible. It can at times even be life-disrupting.

Scratching a particular spot in order to control the itch may seem like a good idea at that particular moment, but in the long run, it ends up harming the skin. Scratch marks may bleed and become infected.

Not only itchy skin, but dry skin showing signs of scales, can become one of the telling signs that the disease may be progressing from advanced to end-stage kidney disease.

However, it is important to remember, that even though advanced chronic kidney disease is associated with pruritus, signs of itching, though less frequently, can be observed in the initial stages of kidney disease as well.

Pruritus associated with chronic kidney disease is often seen to worsen at night. Other reasons for a flare-up are:

• Stress
• Excessive physical activity
• Extreme temperatures like too hot or too cold
• Showers also can trigger pruritus

9. Can CKD-aP Affect Your Mental Health?

More often than not, an important aspect that gets ignored or brushed under the carpet is, can all the scratching and itchy skin on top of dealing with a kidney disease affect your mental health?

It is known that people with itchy skin because of chronic kidney disease can be depressed because of the kind of toll the disease can take. Disturbance in sleep due to the itchy skin only adds to the problem. It is known that stress does make the pruritus worse.

Along with care being taken about the physical health of the person, attention must also be paid to how he/she is coping with mental stress.

10. How To Treat CKD-aP?

First and foremost, the potential causes of CKD-aP must be ruled out.

10.1 Check the Level of Certain Elements

The levels of magnesium, phosphorus, and parathyroid hormone must be checked.

10.2 Prescription of Topical Agents

Topical creams and emollients are prescribed to keep the itchy skin, which produces scratch marks at bay. These creams soothe the skin and keep the dry skin moisturized.

10.3 Certain Drugs To Help With the Itching

If these treatments are not very effective, antihistamine drugs, which help in reducing itching are prescribed by healthcare professionals.

10.4 Taking Prescribed Medicines

If creams and antihistamines do not work, medicines prescribed for nerve pain are prescribed.

10.5 Taking Care of Your Diet

Adopting a kidney-friendly diet and avoiding food items that are rich in phosphorus and magnesium. Maintaining a healthy balance is the key.

10.6 Ultraviolet B Phototherapy

One of the common therapies given in patients who have CKD-aP, but are not in need of a  kidney transplant, is ultraviolet B phototherapy.

10.7 New Prescription Drug on the Horizon

There is a new drug that has been approved by the Food and Drug Administration of the US for use in patients on dialysis and suffering from CKD-ap. This drug is called difelikefalin.

10.8 Use of Topical Treatment

Topical treatments are also performed on the affected sites in order to zero down to pruritus due to chronic kidney disease. Once the condition is appropriately diagnosed, proper treatment modalities can be instituted in order to help keep the itching at bay and the person comfortable.

Treating CKD-aP is a joint effort. The kidney doctor known as a nephrologist and the skin doctor, dermatologist work in collaboration in order to formulate the best treatment plan according to an individual’s need.

11. What Can You Do To Prevent It?

• Immediately bring to your doctor’s attention if you are taking treatment for kidney disease and develop itchy skin.
• Take any medicines prescribed regularly. Any creams or ointments prescribed should also be used diligently.
• Wear loose clothing.
• Try not to expose yourself to extreme weather conditions. Also, protect yourself from sudden temperature changes.
• While taking a shower, avoid hot water. Lukewarm or cold water is a good option.

In conclusion, it is always good to take notice of any changes you might observe and speak to your doctor about it.

Ask questions about the drugs you can take and treatments that can be done if you are already on dialysis. Maintaining a healthy diet and managing stress can also play a role in making ckd-associated pruritus better and also help you manage kidney disease better.

12. Frequently asked questions

12.1 Can itching be caused by Kidney disease?

Answer: Yes, it is commonly known as chronic kidney disease-associated pruritus.

12.2 What can be done to make the itching better?

Answer: Several treatment options are available for the local application of ointments to ultraviolet B therapy.

12.3 Can a hot shower make the itching worse?

Answer: Pruritus and taking hot showers have an established causal relationship. Therefore, taking showers with hot water must be avoided.

Last Updated on December 26, 2023 by soubhik92@gmail.com