Latus Joerg, Lanot Antoine, Ständer Sonja, Sanchez-Alvarez Emilio, Aucella Filippo, Yosipovitch Gil
Department of Nephrology and Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany.
Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France.
Clin Kidney J. 2025 Apr 24;18(5):sfaf096. doi: 10.1093/ckj/sfaf096. eCollection 2025 May.
Of the wide range of symptoms affecting patients with chronic kidney disease (CKD) on haemodialysis, CKD-associated pruritus is one of the most common and burdensome, occurring at moderate-to-severe intensity in 31%-40% of patients, significantly impacting multiple aspects of quality of life, and associated with increased healthcare utilization. Despite the distressing nature of this symptom, clinicians frequently underestimate its prevalence and it is under-reported by patients who may be unaware of the availability of effective treatment options. The identification and management of CKD-associated pruritus should form an essential aspect of patient-centred care; however, patients with CKD may have multiple causes of chronic itch including those of dermatological, systemic, neuropathic and psychogenic origin, and CKD-associated pruritus must be distinguished from these. Together with its highly variable presentation in patients on haemodialysis, the range of potential causes of itch makes differential diagnosis of CKD-associated pruritus challenging. The presence of bilaterally symmetrical and non-dermatomally distributed itching, commonly affecting the back, limbs, chest and head is characteristic of CKD-associated pruritus, although approximately 50% of patients report generalized pruritus. Secondary skin lesions (including excoriation, crusts, impetigo, lichenifications and prurigo also seen in dermatological conditions) may or may not be observed, and xerosis (dry skin) that may exacerbate itching is common. Here, we provide a pragmatic approach to the identification and differential diagnosis of chronic itching in CKD-associated pruritus with the aim of supporting the effective management of this highly distressing symptom in clinical practice.
在接受血液透析的慢性肾脏病（CKD）患者所出现的众多症状中，CKD相关瘙痒是最常见且最令人困扰的症状之一，31%-40%的患者会出现中重度瘙痒，这对生活质量的多个方面产生显著影响，并导致医疗资源利用增加。尽管这种症状令人痛苦，但临床医生常常低估其患病率，而且患者可能因不了解有效治疗方案的存在而未充分报告。CKD相关瘙痒的识别与管理应成为以患者为中心的护理的重要组成部分；然而，CKD患者的慢性瘙痒可能有多种原因，包括皮肤病学、全身性、神经性和精神性起源，必须将CKD相关瘙痒与这些原因区分开来。加上其在血液透析患者中的表现高度可变，瘙痒的潜在原因范围使得CKD相关瘙痒的鉴别诊断具有挑战性。双侧对称且非皮节分布的瘙痒，常见于背部、四肢、胸部和头部，是CKD相关瘙痒的特征，尽管约50%的患者报告有全身性瘙痒。可能会观察到继发性皮肤病变（包括在皮肤病中也可见的抓痕、结痂、脓疱、苔藓化和痒疹），也可能观察不到，而可能加重瘙痒的皮肤干燥（皮肤干燥症）很常见。在此，我们提供一种实用的方法来识别和鉴别诊断CKD相关瘙痒中的慢性瘙痒，旨在支持在临床实践中有效管理这种高度令人痛苦的症状。
