Nephrol Dial Transplant (2002) 17: 1558-1563
© 2002 European Renal Association-European Dialysis and Transplant Association
Invited Comment
Uraemic pruritus—new perspectives and insights from recent trials
1 Robert-Bosch-Hospital Stuttgart, Department of Internal Medicine, Division of General Internal Medicine and Nephrology, Stuttgart, Germany and 2 University Hospital, Division of Clinical Pharmacology, Department of Medicine, Zürich, Switzerland
Keywords: end-stage renal disease; therapy; trials; uraemic pruritus
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Introduction
Uraemic pruritus (UP) remains a frequent and sometimes tormenting problem in patients with advanced or end-stage renal disease [1]. Many attempts have been made to relieve this bothersome symptom in affected patients, however with generally limited success. Whenever a new treatment option is reported to be effective, some time elapses before conflicting results are published; in the meantime, the mood of patients and physicians changes from euphoria to disillusionment. This happened with erythropoetin [2,3] and naltrexone [4,5], the last propagated treatment modalities in this respect.
The main obstacle in the effort to create effective treatment modalities is the incomplete knowledge of the underlying pathophysiological mechanisms. Furthermore, given the great clinical heterogenicity of UP, systematically performed studies are hard to obtain and are therefore sparse.
Clinical features of uraemic pruritus
The intensity and spatial distribution of pruritus varies significantly over time and some patients are affected
Incidence of uraemic pruritus
Pathophysiological concepts of uraemic pruritus
The ‘immuno-hypothesis’
The ‘opioid hypothesis’
Therapeutic options
Local treatment with tacrolimus ointment
Systemic treatment with naltrexone, a µ-receptor antagonist
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