Uraemic Pruritus — RACP Adult Medicine MCQ

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ModerateNephrologyUraemic PruritusRACP Adult Medicine

A 72-year-old woman with CKD stage 5 (eGFR 10 mL/min/1.73 m²) on conservative management develops progressive pruritus refractory to emollients and antihistamines. What is the most appropriate pharmacological treatment?

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Correct answer: B — Gabapentin (renally adjusted)

Uraemic pruritus in CKD/ESKD refractory to emollients and antihistamines can be treated with gabapentin (or pregabalin), which has evidence from RCTs demonstrating efficacy. Dose must be significantly reduced in CKD stage 5 (e.g. gabapentin 100 mg after each dialysis session, or 100 mg nocte in non-dialysis CKD5). Difelikefalin (a kappa-opioid receptor agonist) is an emerging option with TGA provisional approval.

Reference: KHA-CARI – 2013 – Dermatological Manifestations of CKD; KDIGO – 2024 – Uraemic Pruritus