II. Epidemiology of Pruritus in Chronic Renal Failure

  1. Pruritus affects 86% of Hemodialysis patients
  2. Affects 25% of non-dialysis Renal Failure patients
  3. Provocative
    1. Worse in summer
    2. Variable association with Dialysis timing

III. Pathophysiology: Proposed Mechanisms

  1. Secondary Hyperparathyroidism and Hypercalcemia
  2. Hyperphosphatemia
  3. Aluminum overload
  4. Mast cell proliferation
  5. Plasma histamine level increases
  6. Sebaceous Gland atrophy
  7. Eccrine Sweat Gland atrophy
  8. Microangiopathy

IV. Symptoms

  1. Itch occurring in severe paroxysms
  2. Localized in 56% and generalized in 44% of patients

V. Management

  1. Ultraviolet (UV) Light Therapy
    1. Ultraviolet B
    2. Ultraviolet A with Psoralen (PUVA)
  2. Polidocanol (balneotherapy)
  3. Activated Charcoal 6 grams per day
  4. Topical Capsaicin 0.0255%
  5. Cimetidine
  6. Cholestyramine
  7. Ineffective therapies
    1. Poor response to Antihistamines
    2. No relief with Naltrexone
    3. No relief with Ondansetron

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