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Refractory Uraemic Pruritus NB-UVB Phototherapy — ESENeph MCQ

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HardChronic Kidney DiseaseRefractory Uraemic Pruritus NB-UVB PhototherapyESENeph

An adult receiving thrice-weekly in-centre haemodialysis has moderate-to-severe CKD-associated pruritus despite emollients, an antihistamine trial and appropriately dosed gabapentin. Phosphate control and dialysis adequacy have been reviewed. Which NICE-recommended option is now appropriate?

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Correct answer: D — Use intravenous difelikefalin administered in relation to haemodialysis sessions

Explanation lettering: E = shown as C · C = shown as D · D = shown as E

C is correct. NICE TA890 recommends difelikefalin for moderate-to-severe CKD-associated pruritus in adults having in-centre haemodialysis when usual treatments have not worked well enough. The assessment should first address xerosis, phosphate control, dialysis adequacy and alternative dermatological or systemic causes. Difelikefalin is a peripheral kappa-opioid receptor agonist given intravenously in association with dialysis, with adverse effects and concomitant sedatives considered. It is not restricted to transplant failure, and systemic immunosuppression is not routine therapy for uraemic pruritus.

Reference: NICE TA890: difelikefalin for pruritus in haemodialysis: https://www.nice.org.uk/guidance/ta890/chapter/1-Recommendations