Dry, Itchy Skin

Do you have dry, itchy skin? You are not alone! Between 22% and 57% of dialysis patients have experience these symptoms. This condition is called uremic pruritus. Uremic pruritus affects all patients differently. It can happen at any time of the day, on any body part and at different intensities. The body area most commonly affected is the back but the arms, head and abdomen may be also be involved. Dry, itchy skin can significantly affect your quality of life. It can lead to discomfort, depression, anxiety and sleeping disorders.

There are many causes for uremic pruritus. Inadequate dialysis is one cause. The amount of phosphorus and uremic toxins (nitrogenous waste products in the blood) that are usually removed with dialysis decrease with too little dialysis or early terminated treatment times. High phosphorus levels can also cause the dry, itchy skin. Dialysis doesn’t remove all excess phosphorus in the body. In fact, one dialysis treatment removes about 800mg of phosphorus. The extra phosphorus in the body can bind with calcium causing the itchy feeling. Limited fluid intake can be another reason. Dialysis treatments can remove extra fluid and the combination with limited fluid intake can cause dry skin. High parathyroid hormone levels is another cause. When you have kidney failure the kidneys are no longer able to make enough vitamin D or remove all the phosphorus in the body. This leads to low calcium levels that constantly stimulate the parathyroid glands to make more parathyroid hormone causing the itching. Kidney failure can make changes in the sweat glands and oil glands as well. This causes dry skin. Other reasons include allergies, soaps, laundry detergents, lotions, perfumes, long showers or baths with very hot water.

There are many ways you can manage your dry, itchy skin. First, try to figure out what may be causing it. When did it start? What makes it better or worse? Also, talk to your healthcare provider about your symptoms. Don’t scratch your skin because it can make the itching worse and it can damage the skin leading to infections. Complete your full treatment time because it will remove some of the phosphorus and toxins. Adhere to your low phosphorus diet and take your binders as prescribed. It is important to take your phosphate binders as directed to help with controlling the phosphorus levels in your blood. Try to maintain a phosphorus level of 5.5 or less. Take the medication prescribed for controlling your high parathyroid hormone levels as well. Cleanse and moisturize you skin daily. Try soaps with natural, pure ingredients without strong perfumes and chemicals. Soaps and moisturizes for sensitive skin are better choices. Apply moisturizes right after bathing and while the skin is still damp. Avoid alcohol containing lotions.

There are treatment options available for uremic pruritus. Increasing dialysis time can improve your symptoms. Antihistamines, like Benadryl, can treat allergies and relieve the itching. Creams that contain capsaicin, witch hazel, lanolin or camphor can alleviate itching. Sunlight or ultraviolet light treatments in a doctor’s office or treatment center can help. Medications such as Gabapentine, Pregabalin and Sertraline may be effective as well. Talk to your doctor before trying any of these treatments or other options that may be available.

Resources:
https://www.davita.com/kidney-disease/dialysis/life-on-dialysis/skin-problems-and-dialysis/e/5291
https://www.kidney.org/atoz/content/dialysis-dry-itchy-skin
http://www.uptodate.com/contents/uremic-pruritus