Uremic pruritus is a common, adverse symptom among patients with CKD and is associated with reduced quality of life and poor outcomes. It is now recognized as a top research priority. As the complex underlying pathophysiology continues to be teased apart, the potential for novel targeted therapeutics increases. We have seen the early promise of difelikefalin and await ongoing trials of this drug in different formulations and different populations. Other trials studying agents targeting the dysregulated immune response or nerve signaling in uremic pruritus are either being devised or actively contemplated but may be many years away from generating new therapeutics. In the meantime, gabapentin appears to be the most evidence-based widely available uremic pruritus treatment, as long as care is taken with dosing and monitoring of side-effects. As difelikefalin and other potential novel agents come to market, cost-effectiveness assessments of these interventions will help determine if the widespread use of them is feasible amongst renal programs. Despite these caveats, patients with uremic pruritus may look forward to a new decade of understanding, knowledge, and treatment options for this frustrating condition.
Financial support and sponsorship
This work was supported by the Department of Medicine, University of Manitoba, the Chronic Disease Innovation Centre, Seven Oaks Hospital, and he Population Health Research Institute, McMaster University, Hamilton, Canada.
Curr Opin Nephrol Hypertens. 2020;29(5):465-470. © 2020 Lippincott Williams & Wilkins