Itching and chronic kidney disease (CKD)

Itching is a persistent and common complaint in more advanced CKD and kidney failure. It can be called CKD-associated pruritus (which means itching), ‘uraemic pruritus’ or ‘renal pruritus’.

You may have the urge to scratch, but that actually makes the itching worse. Scratching releases substances that induce itching. There is also the danger of damaging the skin.

So. CKD and itching – your questions will now be answered.

What causes itching in CKD?

The precise cause(s) of itching in CKD is not known. The following factors may contribute to it:

Excess wastes in the blood. In CKD, waste products accumulate in the body. This can cause itching but doctors do not know how. This especially happens if there is a lot of urea in the blood. Doctors therefore also call it ‘uraemic itching’. But it is not certain whether urea is really the cause of the itching
Too much phosphate in the blood. High calcium and parathyroid hormone (PTH) levels in the blood may contribute to phosphate-related itching
Anaemia (and iron deficiency). Both of these can occur in CKD, and can contribute to itching – again how is unclear
Dry skin. In CKD, the skin becomes dry and flaky. Dry skin worsens itching. Furthermore, many kidney patients are older. In the elderly, the skin is often thinner and drier
Fluid retention. When fluid builds up (for example in the legs), the skin becomes tight. This can cause itching
Itching is a common complaint in diabetes. Many people with CKD also have diabetes
Anxiety is common – and may contribute to itching
Side effect of medications. The chance of itching increases if you take more than 4 medications per day.

Itching on dialysis

In people on dialysis, the itching can become worse. This can be called ‘dialysis-induced pruritus’. There are several reasons for this:

Toxins levels are high in kidney failure (CKD5)
Anaemia worsens
Phosphate rises
Patients need to take many different medications.

All these factors play a role in itching on dialysis. In a few patients the itching actually decreases – presumably as dialysis removes waste products from the blood that are causing the itching.

Itching after a kidney transplant

After a transplant, itching usually disappears. This is one of the many advantages of a kidney transplant.

What is the treatment for kidney itching?

There is a a lot you and we can do. here goes.

What helps itching from kidney disease? What can I do to reduce my itching?

Avoiding irritants. CKD patients should be cautious with certain soaps, detergents, and skincare products, as they can further irritate the skin. Using gentle, hypoallergenic products can be helpful. Itching can be eased by:

Wearing loose, non-irritating clothing– made of natural fabrics, such as cotton
Avoiding wearing perfumes – or aftershave
Using un-scented shower and bath products
Patting rather than rubbing– your skin dry after a bath or shower
Using an un-scented moisturiser – regarding dry skin and CKD itching, on dry areas of skin, some people also find moisturisers containing menthol and aloe vera can be helpful.

What medical treatments are available for CKD-related itching?

Itching is difficult to treat. It is important to address the (possible) causes of itching outlined above, i.e. correct:

Toxins levels – e.g. increase dialysis dose if on dialysis
Correct anaemia
Correct fluid overload
Reduce phosphate levels – regarding phosphate and CKD itching, phosphate binding tablets (e.g. calcium acetate) can be given, and/or an increased dialysis dose if on dialysis
Reduce the number of medications
Topical treatments. Moisturisers and emollients can help with dry skin, reducing itching. They should be used every day, not just when you are itching, in order to maintain the skin’s barrier prevention. Talk to your pharmacist
Gabapentin, pregabalin and difelikefalin. These are medicines your kidney doctors may consider prescribing for chronic kidney disease-related itch. They can reduce itching by affecting how your nerves work. They can also make you sleepy and dizzy. The dose must be carefully monitored
Antidepressants. These may reduce itching but can take a while to have an effect
Antihistamines. These are often tried for itching. However the mechanism of itching associated with kidney disease is different from allergic itching, and so antihistamines are usually not effective
Phototherapy with ultraviolet B (UVB) light. This may reduce itching but can take a while to have an effect.

Summary

We have described itching and chronic kidney disease (CKD). We hope it’s been helpful.

Other resources

CKDEx has a related article pruritus in patients not on dialysis
Medication for itching in CKD (Hercz, 2020)
These are review articles for health professionals: Mettang, 2014, Cochrane Review, 2020, Osakwe, 2023
These are other sources of advice:
American Academy of Dermatology
American Kidney Fund (US kidney charity)
Cleveland Clinic
KDIGO (US guidelines)
Kidney Care UK (UK kidney charity)
NKF (US kidney charity) advice
NHS website (itchy skin)

The article was reviewed by Dr Emma Murphy (Associate Clinical Professor in Nephrology Nursing). She is an advanced nurse practitioner, with an interest in symptom control in advanced CKD. It is partly based on an article in a CKD patient website called Nieren.nl in the Netherlands.

Last Reviewed on 17 June 2024