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Therapeutic Approach

Uremic pruritus, or more accurately termed chronic kidney disease-associated pruritus (CKD-aP), is a chronic pruritus found in greater than 60% patients undergoing dialysis and associated with worsening kidney function, age, and medical comorbidities. While there are currently no FDA-approved treatments for this condition, several treatments including off label treatments have shown anti-pruritic efficacy. Furthermore, new drugs are under clinical trials and show promising results. The first step of management for all patients with uremic pruritus should be dialysis optimized according to Kt/V targets and topical emollients as the uremic skin is xerotic. Topical therapies should be first-line in mild and/or localized uremic pruritus, while systemic should be pursued in generalized, moderate-to-severe, and/or refractory uremic pruritus. Alternative and adjuvant therapy may be considered on a patient-by-patient basis according to accessibility, practicality, financial status, and other comorbidities. See Table 19-1.

Table 19-1Uremic Pruritus Treatment Table

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