Talking to Your Doctor About Itching When You're on Dialysis

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 chronic kidney disease-associated pruritus (CKD-aP).

You will learn about:

• Chronic kidney disease (CKD) and dialysis

• Why itching can happen when you're on dialysis and what CKD-aP is

• Factors that may cause or add to CKD-aP and itching

• How itching may look and feel

• Talking to your doctor and healthcare team and what to share about itching

The main job of your kidneys is to filter and clean your blood. They remove extra fluid and waste products and help you keep the right amounts of fluid, salt, and minerals.

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

Over time, CKD may lead to kidney failure where your kidneys don't work well enough or they stop working altogether. With kidney failure, you'll need dialysis treatments or a kidney transplant.

Dialysis does the work of removing extra fluid and waste products when your kidneys can't. Hemodialysis is a process where a machine removes blood from your body, filters it through an artificial kidney called a dialyzer to clean it, and then returns the clean blood to your body.

Some people who are living with CKD may notice changes in their skin, such as dryness or changes in color. And most people who are on dialysis will have itchy skin at some point.

CKD-associated pruritus, or CKD-aP, is a long-term itching condition that commonly affects people who are living with CKD or kidney failure. The exact cause is not always known, but a combination of factors may cause it or make it worse, including:

• Extra phosphorus in your body that can bind with calcium and lead to feeling itchy

• High levels of parathyroid hormone (PTH), a hormone that normally helps regulate calcium and phosphorus

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

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

• Not getting the right amount of dialysis or skipping treatments

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

• Not drinking enough liquids

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

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

• Allergy to any part of your dialysis treatment or equipment

• Other health conditions, such as diabetes, liver disease, or allergies

Itchy skin while on dialysis can be different for different people. For many, it often feels like crawling under the skin that's not relieved by scratching and happens on both sides of the body at the same time. 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:

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

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

• On just 1 area of your body -- often your back or arms -- to all over

If your skin is itchy while on dialysis, you're not alone. Chronic itching can be as bad as having chronic pain for some people. It can greatly affect your quality of life -- including your mood and sleep -- interfere with your daily activities, and even lead to anxiety and depression.

It can also affect how your skin looks -- dry and cracked -- and scratching can leave scars or cause bleeding. Scratching and cracked skin may also lead to infections.

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 keeping your skin healthy.

Be sure to tell your doctor or healthcare team member about any itching you have and:

• How it feels

• Where on your body itching happens

• Whether it's all the time or comes and goes

• When itching happens -- time of day; before, during, or after a specific event; or when you feel warm or stressed

• How itching impacts your sleep and daily activities

• Your diet and how much liquid you drink

• What you use on your skin

• Clothing/fabrics you wear and what you use to wash them

• Other health conditions you have

• All medicines you take -- including those you get without a prescription -- and herbals or supplements

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

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

• How can we help manage the itch?

• Are there any lifestyle changes I should make?

• What skincare routine do you recommend?

• What should I do if I 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 Talking to Your Doctor About Itching When You're on Dialysis.

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?