Ways to Manage the Itch When You're on Dialysis

Anita A. Galdieri, PharmD, RPh Disclosures Published on Oct 10, 2022

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 ways to help manage itching while on dialysis.

You will learn about:

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
Ways to help manage itching
Medicines that may be recommended, and their possible side effects
Questions to ask your doctor and healthcare team

Test Your Knowledge

CKD, Dialysis, and Your Skin

Many people who are living with CKD and are on dialysis can have problems with their skin. This can include dry skin, changes in skin color, and even itchy skin.

CKD-associated pruritus, or CKD-aP, is long-term itching that commonly affects people who have 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 phosphorus or parathyroid hormone in your body.

Other Factors That Can Cause or Add to CKD-aP and Itching

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

Not getting the right amount of dialysis or skipping dialysis treatments
Dry skin and decreased sweating
Not drinking enough liquids
High 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 you may have, such as allergies, diabetes, or liver disease

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

Symptoms of CKD-aP

Most people who are on dialysis will have itchy skin at some point, but it can feel and happen differently for different people.

Itching can often feel like crawling just under the skin and happen on both sides of the body. It may also get worse during or just after dialysis, at night, and when you're warm or stressed.

But itching may also 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 most or all of the time
Just 1 area of your body -- often your back or arms -- to all over

Getting Relief

Chronic pruritus can greatly affect your quality of life. And while there's no cure for CKD-aP, there are ways to help manage itching. Talking to your doctor or healthcare team member is the first step toward relief and healthier skin.

Keeping a journal or diary about your itching can help. You can also record your treatments, any side effects, and questions you might have.

And be sure to check with your doctor before using anything to help ease your itching. For certain skin problems, they may recommend you see a dermatologist.

Getting to the Bottom of the Itch

Because CKD-aP and itching can be caused or made worse by a combination of factors, your doctor will likely ask you about:

How the itching feels, and where on your body it happens
Whether it's continuous (happens all the time) or comes and goes
When the itching happens -- time of day and before, during, or after a specific event
If it happens when you feel warm or stressed
Your diet, and how much liquid you drink
What you use on your skin, and clothes you typically wear
Other health conditions you have

Ways to Help Manage the Itch

Ways to help manage itching, including skincare tips, that your doctor may recommend can include:

Changing your dialysis to make sure you're getting the right kind and amount of treatments
Avoiding very hot or dry environments
Eating a diet that limits foods high in phosphorous
Drinking enough liquids
Avoiding fragrances and using unscented moisturizers and bath products
Showering or bathing with warm, not hot, water and then patting, not rubbing, skin dry
Changing your skincare products, toiletries, or household cleaners and detergents
Wearing loose, non-irritating clothes

Medicines That May Be Recommended

As part of your treatment plan, your doctor may also recommend medicines to help manage itching that:

Bind up extra phosphorus in your body so it can be removed
Work on substances or receptors in your body to help control itching
Add moisture to your skin
Decrease skin inflammation (swelling)

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

Possible Side Effects

All treatments can have side effects. Some common ones that may happen with medicines used to manage itching can include:

Stomach pain, nausea, vomiting, diarrhea, or constipation
Headache, dizziness, trouble walking or falls, sleepiness, confusion, or dry mouth or eyes
Skin stinging, burning, redness, or thinning

Not all possible side effects are listed here, so be sure to ask your doctor, pharmacist, or healthcare team member about which can happen with the treatments that you're using.