Cîrstea Ștefania, Orzan Olguța Anca, Zilișteanu Diana Silvia
Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Department of Allergology, Nicolae Malaxa Clinical Hospital, 022441 Bucharest, Romania.
Life (Basel). 2025 Jun 24;15(7):1001. doi: 10.3390/life15071001.
Chronic kidney disease-associated pruritus (CKD-aP) is a distressing symptom that affects both dialysis and non-dialysis patients, significantly impairing their quality of life. Despite its multifactorial pathophysiology, no gold-standard treatment has been established. This review explores various therapeutic options and evaluates their effectiveness based on recent clinical studies and meta-analyses. Therapies targeting novel mechanisms have evolved in recent years. Difelikefalin, a κ-opioid receptor agonist, represents a breakthrough in systemic treatment, demonstrating efficacy with a favorable safety profile. Another opioid-based therapy, nalfurafine, has shown notable symptom relief in multiple clinical studies, with a low risk of abuse. Sertraline, an antidepressant, offers another alternative, although its delayed onset remains a limitation. Nonpharmacologic approaches are also evolving. Phototherapy, particularly UV-B therapy, modulates the immune response, reduces inflammation, and effectively alleviates itching in hemodialysis patients. Personalized treatment strategies are crucial, as responses vary among patients. Further research, including comparative and long-term studies, is essential to refine treatment algorithms and improve patient outcomes. By integrating new pharmacologic and nonpharmacologic options, CKD-aP management is shifting toward a more tailored and effective approach that addresses the individual needs of each patient.
慢性肾脏病相关性瘙痒（CKD-aP）是一种困扰透析和非透析患者的症状，严重损害他们的生活质量。尽管其病理生理机制具有多因素性，但尚未确立金标准治疗方法。本综述探讨了各种治疗选择，并根据近期的临床研究和荟萃分析评估了它们的有效性。近年来，针对新机制的治疗方法不断发展。κ-阿片受体激动剂地夫可特林代表了全身治疗的一项突破，显示出疗效且安全性良好。另一种基于阿片类药物的疗法纳呋拉啡在多项临床研究中显示出显著的症状缓解，滥用风险较低。抗抑郁药舍曲林提供了另一种选择，尽管其起效延迟仍是一个局限。非药物治疗方法也在不断发展。光疗，尤其是UV-B疗法，可调节免疫反应、减轻炎症，并有效缓解血液透析患者的瘙痒。个性化治疗策略至关重要，因为患者的反应各不相同。进一步的研究，包括比较研究和长期研究，对于完善治疗方案和改善患者预后至关重要。通过整合新的药物和非药物选择，CKD-aP的管理正朝着更具针对性和有效性的方法转变，以满足每个患者的个体需求。
