Vifor Fresenius

Learn more about CKD-associated Pruritus

Share your CKD-associated Pruritus practice by completing this questionnaire

Take a closer look at CKD-associated Pruritus with our mode of disease video

Job code: HQ-DFK-2400037. Date of preparation: March 2024

Vifor Fresenius

Learn more about CKD-associated pruritus

Share your CKD&-associated pruritus practice by completing this questionnaire

Take a closer look at CKD-associated pruritus with our mode of disease video

You are viewing a virtual booth from Vifor Pharma. This material is only intended for healthcare professionals (“HCPs”) from Europe. If you are not the intended audience, please do not consult this material. Approval conditions for products may vary country to country. Before prescribing any product, always refer to local materials such as the prescribing information and/or the Summary of Product Characteristics.

Job code: HQ-DFK-2100023. Date of preparation: April 2021

What is
Chronic Kidney Disease-associated Pruritus?

Pruritus in chronic kidney disease (CKD) patients has commonly
been referred to as uraemic pruritus, but as our understanding of the
multifactorial pathogenesis of pruritus in CKD has developed, the term
CKD-associated Pruritus (CKD-aP) is now being used.1,2

The itching may be generalised or localised to one area, which is often
the back, abdomen, head and/or arms.3

Despite over 50 years of research, CKD-aP remains underreported
and undertreated.1,4

Pruritus in chronic kidney disease (CKD) patients has commonly been referred to as uraemic pruritus, but as our understanding of the multifactorial pathogenesis of pruritus in CKD has developed, the term CKD-associated pruritus (CKD-aP) is now being used.1,2

The itching may be generalised or localised to one area, which is often the back, abdomen, head and/or arms.3

Despite over 50 years of research, CKD-aP remains underreported and undertreated.1,4

  1. Verduzco H & Shirazian S. Kidney Int Rep. 2020;5(9):1387–1402.
  2. Patel T, et al. Am J Kidney Dis. 2007;50:11–20.
  3. Manenti L, et al. Drugs. 2009;69(3):251–263.
  4. Rayner H, et al. Clin J Am Soc Nephrol. 2017;12:2000–2007.
  1. Verduzco H & Shirazian S. Kidney Int Rep. 2020;5(9):1387–1402.
  2. Patel T, et al. Am J Kidney Dis. 2007;50:11–20.
  3. Manenti L, et al. Drugs. 2009;69(3):251–263.
  4. Rayner H, et al. Clin J Am Soc Nephrol. 2017;12:2000–2007.
Multifactorial pathophysiology
proposed for CKD-associated pruritus
Below are the proposed mechanisms by which a patient could develop CKD-aP:1

Uraemic toxins

Vitamin A, aluminium, calcium, phosphorus, magnesium

Imbalanced
mu-and kappa-opioid
receptor activity

Overstimulation
of central mu-opioid receptors
Antagonism of peripheral
kappa-opioid receptors

Pro-inflammatory state

↑ Skin microinflammation
Allergy: ↑eosinophils,
mast cells, histamine
↑C-reactive protein,
interleukin (IL)-6, IL-2,
white blood cells, ferritin

Abnormal nerve
conduction

↑ Abnormal skin innervation
and nerve conduction

Uraemic toxins

Vitamin A, aluminium, calcium, phosphorus, magnesium

Imbalanced
mu-and kappa-opioid
receptor activity

Overstimulation
of central mu-opioid receptors

Antagonism of peripheral
kappa-opioid receptors

Pro-inflammatory state

↑ Skin microinflammation
Allergy: ↑eosinophils,
mast cells, histamine
↑C-reactive protein,
interleukin (IL)-6, IL-2,
white blood cells, ferritin

Abnormal nerve
conduction

↑ Abnormal skin innervation
and nerve conduction
  1. Verduzco H & Shirazian S. Kidney Int Rep. 2020;5(9):1387–1402.
  1. Verduzco H & Shirazian S. Kidney Int Rep. 2020;5(9):1387–1402.
Are your haemodialysis patients
suffering in silence?

of all patients in the
DOPPS study reported being
moderately to extremely
bothered by itching1

of all patients in the DOPPS
study reported being
bothered by itching*1

of Medical Directors
included in the DOPPS
study underestimated the
prevalence of pruritus in
their facilities2

*Figure calculated based on total patients reporting being somewhat - extremely bothered by itching.

of all patients in the DOPPS study reported being moderately to extremely bothered by itching1

of all patients in the DOPPS study reported being bothered by itching*1

of Medical Directors included in the DOPPS study underestimated the prevalence of pruritus in their facilities2

*Figure calculated based on total patients reporting being somewhat - extremely bothered by itching.

  1. Sukul N, et al. Kidney Medicine. 2020;3(1):42-53.e1.
  2. Rayner H, et al. Clin J Am Soc Nephrol. (2017);12:2000–2007.
  1. Sukul N, et al. Kidney Medicine. 2020;3(1):42-53.e1.
  2. Rayner H, et al. Clin J Am Soc Nephrol. (2017);12:2000–2007.
Look beneath the surface
To the physical and mental repercussions of CKD-associated pruritus
Click on each item to learn more

DEPRESSION1

dopps design

Increased HEALTHCARE COSTS 1,2

Increased mortality risk 1,3

REDUCED QUALITY OF LIFE 1,4

Poor sleep quality 1,5

DEPRESSION1

Increased HEALTHCARE COSTS1,2

Increased mortality risk1,3

REDUCED QUALITY OF LIFE1,4

Poor sleep quality1,5

DOPPS DESIGN

  1. Sukul N, et al. Kidney Medicine. 2020;3(1):42-53.e1.
  2. Ramakrishnan K, et al. Int J Nephrol Renovasc Dis. 2013;7:1–12.
  3. Narita I, et al. Kidney Int. 2006;69(9):1626–1632.
  4. Rayner H, et al. Clin J Am Soc Nephrol. 2017;12:2000–2007.
  5. Pisoni R, et al. Nephrol Dial Transplant. 2006;21:3495–3505.
  1. Sukul N, et al. Kidney Medicine. 2020;3(1):42-53.e1.
  2. Ramakrishnan K, et al. Int J Nephrol Renovasc Dis. 2013;7:1–12.
  3. Narita I, et al. Kidney Int. 2006;69(9):1626–1632.
  4. Rayner H, et al. Clin J Am Soc Nephrol. 2017;12:2000–2007.
  5. Pisoni R, et al. Nephrol Dial Transplant. 2006;21:3495–3505.
ASSESSING ITCH intensity AND ITCH-RELATED QUALITY OF LIFE IS IMPORTANT TO UNDERSTAND THE BURDEN
OF CKD-ASSOCIATED PRURITUS AND THE BENEFITS OF TREATMENT FOR PATIENTS1,2
Discover these useful assessment scales for measuring itch severity in haemodialysis patients with CKD-associated Pruritus.

WORST-ITCH NUMERICAL RATING SCALE (WI-NRS)

SELF-ASSESSED DISEASE SEVERITY (SADS)

  1. Mathur VS, et al. Clin J Am Soc Nephrol. 2010;5:1410-19.
  2. Phan NC, et al. Acta Derm Venereol. 2012;92:502-7.
  1. Mathur VS, et al. Clin J Am Soc Nephrol. 2010;5:1410-19.
  2. Phan NC, et al. Acta Derm Venereol. 2012;92:502-7.
MANAGING CKD-ASSOCIATED PRURITUS
CAN BE A CHALLENGE
BUT IS A CHALLENGE WORTH TAKING ON1
The treatment approach should be multifaceted and tailored to each patient’s dialysis goals.2,3,
Optimise dialysis
treatment

The first steps in the
management of CKD-aP are
typically to ensure adequate
dialysis, normalise calcium-
phosphate balance, control PTH
to accepted levels, correct any
anaemia and use emollients (for
xerosis).2

Antihistamines

Despite antihistamines being
widely used by patients, there is
no evidence from randomised
controlled trials to support their use.2,4

Corticosteroids

The use of corticosteroids for the
treatment of chronic itching or
long-term use is not recommended.5

Gabapentinoids

A number of placebo-controlled
trials using gabapentinoids have
demonstrated a reduction in itch
severity, however, the adverse
effects associated with them
may limit their use in CKD-aP.3

  1. Ebata T & Takahashi K. Itch. 2019;4(2):e24.
  2. Millington G, et al. Br J Dermatol. 2018;178(1):34–60.
  3. Verduzco H & Shirazian S. Kidney Int Rep. 2020;5(9):1387–1402.
  4. Mathur V, et al. Clin J Am Soc Nephrol. 2010;5:1410–1419.
  5. Patel T, Yosipovitch G. Expert Opin Pharmacother. 2010;11(10):1673-1682.
  1. Davison SN, et al. Kidney Int. 2015;88(3):447-59.
  2. Ebata T & Takahashi K. Itch. 2019;4(2):e24.
  3. Millington G, et al. Br J Dermatol. 2018;178(1):34–60.
  4. Verduzco H & Shirazian S. Kidney Int Rep. 2020;5(9):1387–1402.
  5. Mathur V, et al. Clin J Am Soc Nephrol. 2010;5:1410–1419.
  6. Patel T, Yosipovitch G. Expert Opin Pharmacother. 2010;11(10):1673-1682.
Are your haemodialysis patients
suffering in silence with
CKD-associated Pruritus?
Up to 67% of haemodialysis patients are suffering from CKD-aP1,2
CKD-aP strongly affects patients’ quality of life, disturbs their sleep and makes them more likely to suffer with depression1,3-5
CKD-aP can have a serious impact on health outcomes as well as higher drug utilisation5,6
The pathophysiology of CKD-aP is multifactorial, likely including opioid dysregulation,
immune system dysfunction, toxin deposition and peripheral neuropathy7
Current treatments used off-label in CKD-aP are linked to poor data and/or unfavourable
safety profiles. Diagnosis and effective management of CKD-aP are critical to help improve
quality of life in those affected8-11
Up to 67% of haemodialysis patients are suffering from Chronic Kidney Disease-associated Pruritus1,2
The pathophysiology of Chronic Kidney Disease-associated Pruritus is multifactorial, likely including opioid dysregulation, immune system dysfunction, toxin deposition and peripheral neuropathy3,4
Chronic Kidney Disease-associated Pruritus is one of the most important concerns for patients, as it may strongly affect their quality of life, disturb their sleep and make them more likely to suffer with depression1,4-6
Chronic Kidney Disease-associated Pruritus can have a serious impact on health outcomes as well as higher drug utilisation6,7
Current treatments used off-label in Chronic Kidney Disease-associated Pruritus are linked to poor data and/or unfavorable safety profiles. Diagnosis and effective management of Chronic Kidney Disease-associated Pruritus are critical to help improve quality of life in those affected8-11
1. Sukul N, et al. Kidney Medicine. 2020;3(1):42–53.e1. 2. Aresi G, et al. J Pain Symptom Manage. 2019;58(4):578–586. 3. Yosipovitch G, et al. Acta Derm Venereol. 2001;81:108–111. 4. Pisoni RL, et al. Nephrol Dial Transplant. 2006;21:3495–3505. 5. Ramakrishnan K, et al. Int J Nephrol Renovasc Dis. 2013;7:1-12. 6. Narita I, et al. Kidney Int. 2006;69(9):1626– 1632. 7. Verduzco H & Shirazian S. Kidney Int Rep. 2020;5(9):1387–1402. 8. Mathur VS, et al. Clin J Am Soc Nephrol. 2010;5:1410–1419. 9. Millington GWM, et al. Br J Dermatol. 2018;178(1):34–60. 10. Patel T & Yosipovitch G. Expert Opin Pharmacother. 2010;11(10):1673–1682. 11.Simonsen E, et al. Am J Kidney Dis. 2017;70(5):638-655.
1. Sukul N, et al. Kidney Medicine. 2020;3(1):42–53.e1. 2. Aresi G, et al. J Pain Symptom Manage. 2019;58(4):578–586. 3. Pisoni RL, et al. Nephrol Dial Transplant. 2006;21:3495–3505. 4. Verduzco H & Shirazian S. Kidney Int Rep. 2020;5(9):1387–1402. 5. Yosipovitch G, et al. Acta Derm Venereol. 2001;81:108–111. 6. Ramakrishnan K, et al. Int J Nephrol Renovasc Dis. 2013;7:1-12. 7. Narita I, et al. Kidney Int. 2006;69(9):1626–1632. 8. Mathur VS, et al. Clin J Am Soc Nephrol. 2010;5:1410–1419. 9. Millington GWM, et al. Br J Dermatol. 2018;178(1):34–60. 10. Patel T & Yosipovitch G. Expert Opin Pharmacother. 2010;11(10):1673–1682. 11.Simonsen E, et al. Am J Kidney Dis. 2017;70(5):638-655.
please select from THE options below a
description that BEST describes your profession
please select A COUNTRY from the list

Country

Progress
Q1.
Approximately how many adult patients are
currently receiving chronic haemodialysis at your institution?
Q1. Approximately how many adult patients are currently receiving chronic haemodialysis at your institution?

Please type in the approximate number in the keypad below and press next

Progress
Q2.
Approximately what percentage of your current adult haemodialysis patients have a diagnosis of CKD-associated pruritus *?
Q2. Approximately what percentage of your current adult haemodialysis patients have a diagnosis of CKD-associated pruritus *?

Please use the slider below to select the approximate % and press next

%

0%
100%

*Defined as itching directly related to chronic kidney disease without another comorbid condition explaining the itch1
1. Verduzco H & Shirazian S. Kidney Int Rep. 2020;5(9):1387–1402.

Progress
Q3.
Approximately how many of your current adult haemodialysis patients with a diagnosis of CKD-associated pruritus* are being treated?
Q3: Approximately how many of your current adult haemodialysis
patients with a diagnosis of CKD-associated pruritus* are being treated?

Please use the slider below to select the approximate % and press next

%

0%
100%

*Defined as itching directly related to chronic kidney disease without another comorbid condition explaining the itch1
1. Verduzco H & Shirazian S. Kidney Int Rep. 2020;5(9):1387–1402.

Progress
Q4.
What (if any) medication are your adult patients receiving for CKD-associated pruritus?
Q4: What (if any) medication are your adult patients receiving for CKD-associated pruritus?

Please select all the options that apply and click next

Thank you for completing all the questions

Through the sharing of
knowledge and best practices,
we can continue to strive for
better patient care everyday.

Click here to learn more about CKD-associated Pruritus

Click here to restart the questionnaire

Click here to watch the mode of disease video

#BENEATHTHESURFACE

Click here to learn more about CKD-associated pruritus

Click here to restart the questionnaire

Click here to watch the mode of disease video

#BENEATHTHESURFACE