Mima Yoshihito, Yamamoto Masako, Iozumi Ken
Department of Dermatology, Tokyo Metropolitan Police Hospital, Tokyo, JPN.
Cureus. 2025 May 2;17(5):e83367. doi: 10.7759/cureus.83367. eCollection 2025 May.
Chronic kidney disease-associated pruritus (CKD-aP) is a common and distressing symptom among patients undergoing maintenance hemodialysis and is known to significantly impair quality of life. In contrast, prurigo nodularis (PN), characterized by intensely pruritic nodules, may develop as a result of persistent scratching due to chronic pruritus. While difelikefalin, a peripherally acting κ-opioid receptor (KOR) agonist, has been approved for the treatment of CKD-aP, alternative therapeutic options have not been sufficiently explored in patients who show an inadequate response. Herein, we report a case of a 74-year-old man on long-term dialysis who presented with severe CKD-aP (PP-NRS 9-10) and multiple pruriginous nodules. Although partial improvement was achieved with difelikefalin, moderate pruritus (PP-NRS 7) and residual nodules persisted. Nemolizumab, an interleukin-31 receptor α (IL-31Rα) antagonist approved for the treatment of PN, was subsequently introduced. After two doses, the patient experienced complete resolution of pruritus and marked flattening of nodular lesions. Elevated serum IL-31 levels have been reported in both PN and dialysis-related pruritus, suggesting a shared pathophysiological role of IL-31 in these conditions. The rapid and dramatic response to nemolizumab in this case supports the potential of IL-31 inhibition as a promising treatment strategy for patients with CKD-aP who are unresponsive to KOR agonists. This case represents the first report of sequential use of difelikefalin and nemolizumab for dialysis-associated pruritus and highlights the need for further studies to evaluate the efficacy of IL-31-targeted therapies in this setting.
慢性肾脏病相关性瘙痒（CKD-aP）是维持性血液透析患者中常见且令人苦恼的症状，已知会显著损害生活质量。相比之下，以剧烈瘙痒性结节为特征的结节性痒疹（PN）可能是慢性瘙痒导致持续搔抓的结果。虽然外周作用的κ-阿片受体（KOR）激动剂地夫可法林已被批准用于治疗CKD-aP，但对于反应不佳的患者，尚未充分探索其他治疗选择。在此，我们报告一例74岁长期透析男性患者，其患有严重的CKD-aP（PP-NRS 9-10）和多个瘙痒性结节。尽管使用地夫可法林后有部分改善，但中度瘙痒（PP-NRS 7）和残留结节仍持续存在。随后引入了已被批准用于治疗PN的白细胞介素-31受体α（IL-31Rα）拮抗剂奈莫利珠单抗。两剂后，患者瘙痒完全缓解，结节性病变明显变平。在PN和透析相关瘙痒中均报告了血清IL-31水平升高，提示IL-31在这些病症中具有共同的病理生理作用。该病例中对奈莫利珠单抗的快速显著反应支持了抑制IL-31作为对KOR激动剂无反应的CKD-aP患者的一种有前景的治疗策略的潜力。本病例是关于地夫可法林和奈莫利珠单抗序贯用于透析相关性瘙痒的首例报告，并强调需要进一步研究以评估IL-31靶向治疗在这种情况下的疗效。
