What You Can Do When You're on Dialysis and Have Itching

This article is for people who are on dialysis and their care partners, or anyone who wants to learn more about dialysis and itching. The goal of this activity is to help you talk to and work with your doctor and healthcare team about ways to help manage itching while on dialysis.

You will learn about:

• Changes to your skin when you're on dialysis

• Why itching can happen

• What chronic kidney disease-associated pruritus (CKD-aP) is

• Factors that can affect itching and CKD-aP

• Ways to help manage the itch

• Talking to your doctor and healthcare team about itching, and questions you can ask

Many people who are living with chronic kidney disease (CKD) can have problems with their skin such as dryness, changes in skin color, and itchiness. In fact, most people who are on dialysis will have itchy skin at some point.

CKD-associated pruritus, or CKD-aP, is long-term itching that can commonly happen when you're living with CKD or kidney failure. The exact cause of itching is not always known, but it may be caused or made worse by a combination of factors, including high levels of parathyroid hormone (PTH) or extra phosphorus in your body.

Other factors that may cause or add to CKD-aP and itching can include:

• Changes in your immune system or in the signals your brain sends to the rest of your body

• The incorrect amount of dialysis or skipping treatments

• Dry skin and decreased sweating

• Not drinking enough liquids

• Increased magnesium or aluminum or a buildup of urea (a waste product) in your body

• Hot weather or bathing or showering with water that's too hot

• Other health conditions, such as diabetes, liver disease, or allergies (including allergy to the dialysis treatment or equipment)

CKD-aP is not related to your race or ethnicity, your age, how long you've been on dialysis, or the cause of CKD.

Itchy skin while on dialysis can look and feel different for different people. For many, it can feel like crawling under the skin on both sides of the body at the same time that's not relieved by scratching. It may also get worse during or just after dialysis treatment, at night, and when you're warm or stressed.

But itching can happen at any time of the day on any part of your body and range from:

• Mildly irritating to so bad that it interferes with your daily activities

• Happening once in a while to all or most of the time

• 1 area of your body to all over

Chronic itching can greatly affect your quality of life and impact your mood and sleep, interfere with your daily activities, and even lead to anxiety and depression. It can also affect how your skin looks, and scratching can cause bleeding or scars and may lead to infection.

But there are ways to help manage the itch and talking to your doctor or healthcare team member is the first step toward getting relief and healthier skin.

Ways to help manage itching and take care of your skin that your doctor and healthcare team may recommend can include:

• Changing your dialysis treatments to make sure you're getting the right kind and amount 

• Limiting high-phosphorous foods

• Drinking enough liquids

• Using unscented moisturizers and bath products

• Showering or bathing with warm (not hot) water and patting (not rubbing) skin dry

• Avoiding hot or dry places, fragrances, and irritating clothes or fabrics

• Changing your skincare products, household cleaners, or detergents

• Medicines

Check with your doctor before using anything to help ease itching. For certain skin problems, they may recommend you see a specialist, such as a dermatologist.

Your doctor may recommend medicines that help manage itching by:

• Binding up and removing extra phosphorus (such as lanthanum carbonate)

• Working on substances or receptors in your body (such as difelikefalin)

• Decreasing skin inflammation or swelling (such as hydrocortisone)

Depending on which medicine they recommend, it may be taken orally (by mouth), by injection, or used topically on your skin.

All medicines can have side effects. Some that may happen with medicines used to help manage itching can include nausea, stomach pain, diarrhea, headache, sleepiness, dizziness, trouble walking or falls, or skin burning or thinning. These are not all possible side effects -- ask your doctor about which can happen with your treatments. 

If your skin is itchy while you're on dialysis, you're not alone. So don't wait -- be sure to tell a member of your healthcare team so you can get on the path to relief. 

You'll want to tell them about:

• How the itching feels and where on your body it happens

• When it happens and for how long

• How itching impacts your sleep and daily life

• Your diet and skincare products

• Other health conditions you have and all medicines you take, including any you tried for itching

Keeping a journal or diary to record any itching, treatment and any side effects, and questions you might have can help.

Questions you can ask about itching while on dialysis can include:

• What may be causing the itch?

• What can we do to help manage itching and keep my skin healthy?

• What treatments are available, and what are their side effects?

• Are there any lifestyle changes I should make?

• What skincare routine do you recommend?

• What should I do if I start to feel stressed or depressed?

• Is there a support group I can join?

• Where can I find more information and resources?

Congratulations!

You have successfully completed the program What You Can Do When You're on Dialysis and Have Itching.

View Additional Materials on this topic that you may find useful:

Kidney Disease

Chronic Kidney Disease (CKD)

Chronic Kidney Disease Basics

Kidney Failure

What Is Hemodialysis?