Lanot Antoine, Kottler Diane, Béchade Clémence
UNICAEN, néphrologie, Normandie université, CHU de Caen Normandie, 14000 Caen, France; UNICAEN, UFR de médecine, Normandie Université, 2, rue des Rochambelles, 14032 Caen cedex, France; ANTICIPE U1086 Inserm-UCN, centre François-Baclesse, 14000 Caen, France.
UNICAEN, dermatologie, Normandie Université, CHU de Caen Normandie, 14000 Caen, France.
Nephrol Ther. 2021 Dec;17(7):488-495. doi: 10.1016/j.nephro.2021.07.002. Epub 2021 Oct 13.
Pruritus associated with chronic kidney disease is a frequent and disabling symptom in patients with severe chronic kidney disease treated by dialysis. It is associated with a poor quality of life, an increased risk of comorbidities and even mortality. Nevertheless, its prevalence is underestimated by nephrologists. The pathophysiology of pruritus associated with chronic kidney disease is not well understood, but several mechanisms seem to contribute to its occurrence: accumulation and skin deposition of uremic toxins, peripheral neuropathy causing an activation of the pruritogenic cowhage pathway, chronic microinflammation, opioid imbalance, and kidney disease-related skin xerosis. Optimization of the treatment of chronic kidney disease treatment, of dialysis parameters, and general skin care measures should always be performed prior to the introduction of systemic therapy targeting one or more of these mechanisms. The available therapeutic trials remain mostly at high risk of bias, with small patient numbers. Gabapentinoids are the molecules recommended as first-line therapy. Peripheral opioid agonists could find a place of choice in the treatment of pruritus associated with chronic kidney disease and will soon be available in France. The low level of evidence for the other molecules does not currently allow us to specify a second-line treatment for this condition.
与慢性肾脏病相关的瘙痒是接受透析治疗的重度慢性肾脏病患者常见且致残的症状。它与生活质量差、合并症风险增加甚至死亡率相关。然而，肾病学家对其患病率估计不足。与慢性肾脏病相关的瘙痒的病理生理学尚未完全了解，但有几种机制似乎促成了其发生：尿毒症毒素的蓄积和皮肤沉积、导致致痒性刺蒴麻途径激活的周围神经病变、慢性微炎症、阿片类物质失衡以及与肾病相关的皮肤干燥。在引入针对这些机制中一种或多种的全身治疗之前，应始终先优化慢性肾脏病的治疗、透析参数以及一般皮肤护理措施。现有的治疗试验大多存在高偏倚风险，且患者数量较少。加巴喷丁类药物是推荐作为一线治疗的分子。外周阿片类激动剂在慢性肾脏病相关瘙痒的治疗中可能会成为首选药物，且很快将在法国上市。目前其他分子的证据水平较低，尚无法明确针对这种情况的二线治疗方案。
