Dialysis: Talking to Your Doctor About Your Skin

This article is for people who are living with chronic kidney disease (CKD) and are on dialysis, their care partners, or anyone who wants to learn more about dialysis and their skin. The goal of this activity is to help people talk to and work with their doctors about their skin while on dialysis.

You will learn about:

• CKD and dialysis

• Changes that can happen with your skin while living with CKD and on dialysis

• What CKD-associated pruritus (CKD-aP) is, its symptoms, and what can cause it

• Talking to your doctor and healthcare team about your skin and your quality of life

Chronic kidney disease, or CKD, is a long-term condition where your kidneys become damaged and can't filter and clean your blood properly. Waste products and extra fluid can then build up in your body and lead to problems such as high blood pressure, heart disease, stroke, and even death.

Over time, CKD can lead to kidney failure where your kidneys can't work well enough on their own or stop working altogether. If this happens, you'll need dialysis or a kidney transplant to survive.

Dialysis does the work your kidneys can't by removing waste products and extra fluid. In hemodialysis, a machine removes blood from your body, filters it through an artificial kidney called a dialyzer, and then returns the cleaned blood to your body.

Some people who are living with CKD and are on dialysis may notice changes with their skin such as:

• Itching or CKD-associated pruritus (CKD-aP)

• Dry skin due to changes in your sweat glands and oil glands

• Changes in skin color from pigments staying in your skin that would normally be removed by your kidneys

Talking to your doctor or a member of your healthcare team about what skin conditions may happen can help you find ways to prevent or manage them as part of your treatment plan.

CKD-aP is long-term pruritis, or itching, that can commonly affect people who are living with CKD or have kidney failure.

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

CKD-aP is thought to be caused or made worse by a combination of factors, including:

• High levels of phosphorus in your body that can bind with calcium and lead to feeling itchy

• High levels of parathyroid hormone, which helps to regulate calcium and phosphorus

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

• Dry skin and decreased sweating

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

• Not getting the right amount of dialysis or skipping treatments

• Allergy to any part of your dialysis treatment or equipment (such as the tubing), or to certain cleaning products, soaps, detergents, dyes, lotions, or fragrances

• Not getting enough liquids between dialysis treatments

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

• Other health conditions you may have, such as diabetes or liver disease

Most people who are on dialysis will have itchy skin at some point. The itching can feel like crawling just below the skin and tends to happen on both sides of the body at the same time.

But itching can be different for different people. It can happen at any time of the day on any part of the body and can range from:

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

• Happening once in a while (comes and goes) to most or all of the time

• On 1 area of your body (often your back or arms) to all over or your whole body

Itching can also sometimes get worse during or just after dialysis, at night, and when you're warm or under stress.

If your skin is itchy while you're on dialysis, you're not alone. For some people, chronic pruritus has been shown to be as bad as having chronic pain. It can greatly affect your quality of life by impacting your mood, causing sleep problems, and can even lead to anxiety and depression.

Itching can also affect how your skin looks. It can be dry and cracked, and scratching can leave scars or cause bleeding that can lead to infection.

Hemodialysis often takes about 3 to 5 hours for a treatment and may take place in a hospital or a dialysis center a few times a week, depending on what your doctor recommends. Some people can even do hemodialysis at home, but at-home treatments are not for everyone.

You may be seeing different doctors and healthcare team members for your CKD and dialysis. Talking to them about any itching you may have is the first step to getting relief and keeping your skin healthy.

Be sure to tell them about what areas itch, when, and how the itching feels. Keeping a journal or diary can help you keep track and may also help uncover factors that may be causing or adding to your itching.

Questions you can ask your doctor about your skin while on dialysis can include:

• What kind of skin problems can happen and what symptoms should I look for?   

• What can I do to help keep my skin as healthy as possible?

• How often should I be getting dialysis?

• Is there a support group I can join?

• Where can I find more information and resources?

Congratulations!

You have successfully completed the program Dialysis: Talking to Your Doctor About Your Skin.

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

Kidney Disease

Chronic Kidney Disease (CKD)

Kidney Failure

What Is Hemodialysis?