Uraemic itch in palliative care

For patients with uraemia associated with advanced kidney disease (most of whom are likely to be receiving dialysis), in addition to general skincare measures, gabapentin and pregabalin can relieve itch. Suitable regimens are:

Dose adjustments may be required for patients receiving dialysis—seek specialist advice.

Assess the effectiveness of therapy and consider stopping gabapentin or pregabalin if no benefit is seen after 1 week, or sooner if the patient experiences adverse effects.Simonsen, 2017

If itch persists despite the above therapy, see Undifferentiated or other causes of itch in palliative care for management; dose adjustments may be required depending on the drug and degree of kidney impairment.

For patients receiving dialysis, modifying their haemodialysis prescription can improve itch—discuss with the patient’s nephrologistSimonsen, 2017.

Low-dose capsaicin cream (0.025%), montelukast and thalidomide may relieve uraemic itch; however, because of associated adverse effects, they are rarely used in clinical practice. Ondansetron is no longer recommendedSimonsen, 2017.

Ultraviolet B phototherapy can be effective for uraemic itch, but the burden of treatment is significant (administered 3 times a week) and ongoing therapy becomes impractical at the end of life.

For other aspects of palliative care for patients with chronic kidney disease, see Principles of palliative care for chronic kidney disease.