Lettera del Presidente.

Translated title of the contribution: Uremic pruritus: an unresolved challenge

F. Aucella, A. Gesuete

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Pruritus is a common and unpleasant symptom in the dialysis setting, affecting about half of all hemodialysis and peritoneal dialysis patients. It has a great impact on patients' quality of life and is also associated with increased mortality. The pathogenesis of uremic pruritus (UP) is clearly multifactorial and still poorly understood. At least four main hypotheses have been put forward: dermatological abnormalities, an immune-system derangement that results in a proinflammatory state, an imbalance of the endogenous opioidergic system, and a neuropathic mechanism. The neurophysiology of itch has been shown to be quite similar to that of pain, supporting the hypothesis that the two phenomena may be closely related in dialysis patients, who often also experience uremic neuropathy. Moreover, an array of other triggering factors may include uremic toxins, systemic inflammation, cutaneous xerosis, and common comorbidities such as diabetes mellitus, endocrinopathies and viral hepatitis. The first step in the treatment of UP focuses on some general strategies that include the optimization of the dialysis schedule using biocompatible membranes such as polymethyl methacrylate, and the control of the divalent ion metabolism. The second step may be local therapy with skin emollients and capsaicin creams. More specific treatments that appear promising but have not been proven to be definitively efficacious include UVB light, gabapentin and the novel k-opioid-agonist nalfurafine. Nephrologists, who still tend to neglect this disabling symptom, need to be aware that UP is associated with poorer patient outcomes and that a stepwise therapeutic approach is now available.

Original languageItalian
Pages (from-to)585-599
Number of pages15
JournalGiornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
Volume26
Issue number5
Publication statusPublished - Sep 2009

Fingerprint

Pruritus
Dialysis
Emollients
Skin
Neurophysiology
Capsaicin
Peritoneal Dialysis
Polymethyl Methacrylate
Therapeutics
Opioid Analgesics
Hepatitis
Renal Dialysis
Comorbidity
Immune System
Diabetes Mellitus
Appointments and Schedules
Quality of Life
Ions
Inflammation
Light

ASJC Scopus subject areas

  • Nephrology

Cite this

Lettera del Presidente. / Aucella, F.; Gesuete, A.

In: Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia, Vol. 26, No. 5, 09.2009, p. 585-599.

Research output: Contribution to journalArticle

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