Uraemic Pruritus — ESENeph MCQ

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HardHaemodialysisUraemic PruritusESENeph

A 60-year-old man with CKD G5 on haemodialysis develops severe pruritus unresponsive to emollients, optimised dialysis, and correction of calcium/phosphate/PTH. What pharmacological treatment has evidence for uraemic pruritus in dialysis patients?

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Correct answer: D — Difelikefalin

Difelikefalin (Kapruvia) is a selective kappa-opioid receptor agonist specifically licensed for moderate-to-severe pruritus associated with CKD in adults undergoing haemodialysis. The KALM-1 and KALM-2 trials demonstrated significant reduction in pruritus intensity. It is administered IV post-dialysis. While Gabapentin and other agents have been used off-label, Difelikefalin has the strongest evidence base and is the first licensed treatment for CKD-associated pruritus.

Reference: FDA/EMA 2022 – Difelikefalin Approval; KALM-1 and KALM-2 Trials – NEJM 2020