

Uraemic pruritus


Uraemic pruritus — codes and concepts

What is uraemic pruritus?


Uraemic pruritus is not associated with sex, age, ethnicity, duration of dialysis, or cause of renal failure. Pruritus does not arise when uraemia is due to acute renal failure.

What are the signs and symptoms of uraemic pruritus?



Uraemic pruritus (renal itch)

What are the complications of uraemic pruritus?



What causes uraemic pruritus?


  • Dry skin
  • Reduced sweating
  • Abnormal metabolism of calcium and phosphorus / raised parathyroid hormone
  • Accumulation of toxins
  • Sprouting of new nerves
  • Systemic inflammation
  • Co-existing medical problems, particularly diabetes and liver disease.

Some patients have acquired perforating collagenosis.

What is the treatment of uraemic pruritus?



Menthol and camphor may be added to an emollient to cool the skin and relieve the itch. Any localised itch may be reduced by frequent applications of topical capsaicin if tolerated.


Other treatments that have been reported to help some individuals include:

  • Gabapentin and pregabalin in small doses (eg, 100-300 mg gabapentin, three times weekly)
  • Nalfurafine (opioid agonist)
  • Activated charcoal
  • Thalidomide
  • Cholestyramine
  • Ondansetron
  • Dupilumab.

In 2019, in a Phase III clinical trial, an agonist of kappa opioid receptors, difelikefalin, was reported to relieve the itch in haemodialysis patients significantly better than placebo.

Kidney transplantation usually results in resolution of uraemic pruritus.

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Related information



  • Textbook of Dermatology. Jean L. Bolognia and Joseph L. Jorizzo, Ronald P Rapini. Second edition. Mosby Publications.
  • Manenti L. et al. Uraemic pruritus, clinical characteristics, pathophysiology and treatment. Drugs 2009; 69(3)251-263.
  • Silverberg J.I., Brieva J. A successful case of dupilumab treatment for severe uremic pruritus. JAAD Case Reports 2019; 5(4):339-341. Journal.
  • Fishbane S, Jamal A, Munera C, Wen W, Menzaghi F; KALM-1 Trial Investigators. A Phase 3 Trial of Difelikefalin in Hemodialysis Patients with Pruritus. N Engl J Med. 2019 Nov 8. doi: 10.1056/NEJMoa1912770. [Epub ahead of print] PubMed PMID: 31702883.
  • Eusebio-Alpapara KMV, Castillo RL, Dofitas BL. Gabapentin for uremic pruritus: a systematic review of randomized controlled trials. Int J Dermatol. 2020 Apr;59(4):412-422. doi: 10.1111/ijd.14708. Epub 2019 Nov 28. PMID: 31777066.

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