Advances in Clinical and Experimental Medicine
2020, vol. 29, nr 6, June, p. 769–772
Publication type: review article
Pruritus in renal transplant recipients: Current state of knowledge
1 Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
2 Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
Chronic itch (CI) is the most common symptom in dermatology. It is considered a great burden with a large impact on patients’ quality of life, interfering with everyday activities. During the course of chronic kidney disease (CKD) many patients develop end-stage renal disease (ESRD)-associated CI (ESRDCI). Its pathogenesis is yet to be fully explained, but multiple mechanisms have been described, including, among others, dysregulation of calcium, phosphorus, parathyroid hormone and vitamin D axis, microinflammation, and accumulation of uremic toxins. The treatment consists of both topical and systemic therapy, but unfortunately it is usually difficult and unsatisfactory. Renal transplantation (KTx) as the best renal replacement therapy improves considerably the patient’s life quality and decreases the mortality rate. However, its influence on CI has not been well described. In this review, we presented the available literature on the influence of KTx on ESRDCI and demonstrated the possible ways in which transplanted kidney could help patients suffering from CI.
kidney transplantation, pruritus, uremia
- Hill NR, Fatoba ST, Oke JL, et al. Global prevalence of chronic kidney disease: A systematic review and meta-analysis. PLoS One. 2016;11(7):e0158765.
- Szczeklik A, Gajewski P. Interna Szczeklika 2018. Kraków, Poland: Medycyna Praktyczna; 2018.
- Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Prim Care. 2008;35(2):329–344,vii.
- Chargin L, Keil H. Skin diseases in nonsurgical renal disease. AMA Arch Derm. 1932;26(2):314–335.
- Reszke R, Szepietowski JC. End-stage renal disease chronic itch and its management. Dermatol Clin. 2018;36(3):277–292.
- Schricker S, Weisshaar E, Kupfer J, Mettang T. Prevalence of pruritus in a single cohort of long-term kidney transplant recipients. Acta Derm Venereol. 2020;100(4):adv00066.
- Altmeyer P, Kachel HG, Schafer G, Fassbinder W. Normalization of uremic skin changes following kidney transplantation [in German]. Hautarzt. 1986;37(4):217–221.
- Panuccio V, Tripepi R, Bellantoni M, et al. Pruritus and quality of life in renal transplant patients. Clin Transplant. 2017;31(3). doi:10.1111/ctr.12893
- Moloney FJ, Keane S, O’Kelly P, Conlon PJ, Murphy GM. The impact of skin disease following renal transplantation on quality of life. Br J Dermatol. 2005;153(3):574–578.
- Amro A, Waldum-Grevbo B, von der Lippe N, Brekke FB, Miaskowski C, Os I. Symptom clusters from dialysis to renal transplantation: A five-year longitudinal study. J Pain Symptom Manage. 2016;51(3):512–519.
- Avermaete A, Altmeyer P, Bacharach-Buhles M. Skin changes and tumours after renal transplantation. Nephron. 2002;91(2):188–194,discussion 194–186.
- Tăranu T, Covic A, Buhaescu I, Taranu T. Drug-induced dermatological pathology in renal transplantation patients [in Romanian]. Rev Med Chir Soc Med Nat Iasi. 2005;109(1):36–39.
- Yates JE, Bleyer AJ, Yosipovitch G, Sangueza OP, Murea M. Enigmatic pruritus in a kidney transplant patient. Clin Kidney J. 2013;6(2):194–198.
- Murtagh FE, Addington-Hall JM, Edmonds PM, et al. Symptoms in advanced renal disease: A cross-sectional survey of symptom prevalence in stage 5 chronic kidney disease managed without dialysis. J Palliat Med. 2007;10(6):1266–1276.
- Pisoni RL, Wikstrom B, Elder SJ, et al. Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2006;21(12):3495–3505.
- Hayani K, Weiss M, Weisshaar E. Clinical findings and provision of care in haemodialysis patients with chronic itch: New results from the German Epidemiological Haemodialysis Itch Study. Acta Derm Venereol. 2016;96(3):361–366.
- Welz-Kubiak K, Reszke R, Szepietowski JC. Pruritus as a sign of systemic disease. Clin Dermatol. 2019;37(6):644–656.
- Susel J, Batycka-Baran A, Reich A, Szepietowski JC. Uraemic pruritus markedly affects the quality of life and depressive symptoms in haemodialysis patients with end-stage renal disease. Acta Derm Venereol. 2014;94(3):276–281.
- Ibrahim MK, Elshahid AR, El Baz TZ, Elazab RM, Elhoseiny SA, Elsaie ML. Impact of uraemic pruritus on quality of life among end stage renal disease patients on dialysis. J Clin Diagn Res. 2016;10(3):WC01–05.
- Kaysen GA. The microinflammatory state in uremia: Causes and potential consequences. J Am Soc Nephrol. 2001;12(7):1549–1557.
- Morton CA, Lafferty M, Hau C, Henderson I, Jones M, Lowe JG. Pruritus and skin hydration during dialysis. Nephrol Dial Transplant. 1996;11(10):2031–2036.
- Kurban MS, Boueiz A, Kibbi AG. Cutaneous manifestations of chronic kidney disease. Clin Dermatol. 2008;26(3):255–264.
- Makhlough A, Emadi N, Sedighi O, Khademloo M, Bicmohamadi AR. Relationship between serum intact parathyroid hormone and pruritus in hemodialysis patients. Iran J Kidney Dis. 2013;7(1):42–46.
- Wikstrom B, Gellert R, Ladefoged SD, et al. Kappa-opioid system in uremic pruritus: Multicenter, randomized, double-blind, placebo-controlled clinical studies. J Am Soc Nephrol. 2005;16(12):3742–3747.
- Aliasgharpour M, Zabolypour S, Asadinoghabi A, Haghani H, Lesanpezeshki M. The effect of increasing blood flow rate on severity of uremic pruritus in hemodialysis patients: A single clinical trial. J Natl Med Assoc. 2018;110(3):270–275.
- Abecassis M, Bartlett ST, Collins AJ, et al. Kidney transplantation as primary therapy for end-stage renal disease: A National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol. 2008;3(2):471–480.
- Wolley MJ, Hutchison CA. Large uremic toxins: An unsolved problem in end-stage kidney disease. Nephrol Dial Transplant. 2018;33(Suppl 3):iii6–iii11.
- Cupisti A, Piccoli GB, Gallieni M. Charcoal for the management of pruritus and uremic toxins in patients with chronic kidney disease. Curr Opin Nephrol Hypertens. 2020;29(1):71–79.
- Zaza G, Pontrelli P, Pertosa G, et al. Dialysis-related systemic microinflammation is associated with specific genomic patterns. Nephrol Dial Trans-plant. 2008;23(5):1673–1681.
- Bouquegneau A, Salam S, Delanaye P, Eastell R, Khwaja A. Bone disease after kidney transplantation. Clin J Am Soc Nephrol. 2016;11(7):1282–1296.
- Bolton CF, Baltzan MA, Baltzan RB. Effects of renal transplantation on uremic neuropathy: A clinical and electrophysiologic study. N Engl J Med. 1971;284(21):1170–1175.
- Agarwal A, Anand IS, Sakhuja V, Chugh KS. Effect of dialysis and renal transplantation on autonomic dysfunction in chronic renal failure. Kidney Int. 1991;40(3):489–495.
- Whitaker RH, Hamilton D. Effect of transplantation on non-renal effects of renal failure. Br Med J (Clin Res Ed). 1982;284(6311):221–222.
- Oh CC, Lee HY, Tan BK, Assam PN, Kee TYS, Pang SM. Dermatological conditions seen in renal transplant recipients in a Singapore tertiary hospital. Singapore Med J. 2018;59(10):519–523.
- Alper S, Kilinc I, Duman S, et al. Skin diseases in Turkish renal transplant recipients. Int J Dermatol. 2005;44(11):939–941.
- Yamamoto T, Tominaga Y, Okada M, et al. Characteristics of persistent hyperparathyroidism after renal transplantation. World J Surg. 2016;40(3):600–606.