The intense itching that can be an effect of chronic kidney disease (CKD), and one often overlooked, was reviewed in an article that also highlighted investigative treatments “that may soon influence” its management.
The article, “Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges” discusses the difficulty of diagnosing this condition , as well as the medical complications associated with it. It was published in the International Journal of Nephrology and Renovascular Disease.
Itching, or pruritus, associated with CKD is a distressing condition that can negatively affect patients’ quality of life, including their sleep and mood. Previous research has shown that people with itching associated with CKD have a higher rate of depression and mortality.
Although the condition affects a large proportion of dialysis patients, scientists have failed to developed effective treatments in more than 40 years of research. Largely, this is because its underlying cause is not well understood. Tools used by doctors to diagnose the condition are also not standardized, and clinical trials testing new treatments have been poorly designed.
But “there is new hope,” according to Dr. Shayan Shirazian of the Division of Nephrology in Department of Medicine at Winthrop University Hospital, in Mineola, New York, and the study’s co-authors.
A number of clinical trials testing new compounds to treat CKD-associated itching recently ended with “promising results.” These compounds include nalfurafine and nalbuphine hydrochloride, which both bind to a receptor called the kappa opioid receptor (KOR) and activate it. Once activated, KOR can change nociception, which is the ability to feel pain, and is also involved in the control of movement and mood.
Nalfurafine (under the brand name Remitch) is currently approved for use only in Japan, and nalbuphine hydrochloride is still under investigation.
The authors conclude by recommending that patients should first be treated with emollient cream, a moisturizer directly applied to the skin to cover it with a protective film and reduce water loss, to control the itching. They suggest that for patients who do not respond to such creams, the treatments now under investigation may be future options.