Uraemic Pruritus — RACP Adult Medicine MCQ

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ModerateNephrologyUraemic PruritusRACP Adult Medicine

A 60-year-old man with CKD stage 5 on haemodialysis presents with generalised pruritus. Skin examination shows excoriations but no primary rash. Calcium is 2.4 mmol/L, phosphate 2.5 mmol/L, PTH 55 pmol/L. His pruritus is worst after dialysis. What is the most likely cause?

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Correct answer: C — Uraemic pruritus

Generalised pruritus without primary rash in a haemodialysis patient with hyperphosphataemia and elevated PTH is uraemic pruritus. It affects 40-60% of dialysis patients. Pathogenesis involves uraemic toxins, hyperparathyroidism, and immune dysregulation. Treatment: optimise dialysis adequacy, control phosphate (phosphate binders), emollients, gabapentin/pregabalin (most effective pharmacotherapy), and difelikefalin (kappa-opioid agonist — recently approved).

Reference: KHA-CARI – 2024 – Uraemic Pruritus; DOPPS Study