Itching is common in kidney disease, including rare diseases like C3 glomerulopathy (C3G) and immune complex membranoproliferative glomerulonephritis (IC-MPGN). Also called pruritus, itching usually develops later in end-stage kidney disease but can occur earlier as well.

If the itching is associated with kidney damage, it may be referred to as uremic pruritus or chronic kidney disease-associated pruritus (CKD-aP). Someone living with kidney disease can experience itching due to kidney disease itself or as a result of treatments.

If you have kidney disease and are also experiencing itching, talk with your healthcare provider about possible treatment options. Other conditions associated with chronic kidney disease, like gout, can also be associated with itching. Although it seems to be a minor symptom, itching can be extremely uncomfortable and may lead to skin infections. Usually, the itching in CKD-aP affects the whole body, but sometimes it can affect only the face, back, or arms. Your doctor may recommend prescription medications and treatments you can do at home to help relieve itching.

Why Kidney Disease Causes Itching

There are many theories explaining why kidney disease can cause itching. However, the most accepted idea is that chronic kidney damage slowly reduces the kidney’s ability to filter out toxins, waste products, and other natural substances. This condition leads to uremia — high levels of urea and creatinine in the blood, along with other toxins and imbalances in fluid, electrolytes, and certain hormones. High levels of uremic toxins can cause itching. Also, other substances that are increased in the blood can cause itching, such as parathyroid hormone, calcium, magnesium, and phosphate. The buildup of these products can result in inflammation, which can cause itching.

Other possible causes of CKD-aP include immune system imbalances, nerve damage in the skin, or problems with opioid receptors that affect the feeling of itching.

Itching Associated With Other Causes

If you’re living with kidney disease, not all itching may be due to organ damage. There may be causes that are unrelated to your kidneys. For example, some people may have preexisting skin conditions that cause itching, including dry skin and eczema. Itching can also be a sign of an allergic reaction to plants, foods, and medications.

Itching in C3G and IC-MPGN

People living with C3G and IC-MPGN can also experience itching. Similarly to other forms of kidney disease, C3G and IC-MPGN can cause itching through the buildup of harmful substances, nerve damage, and inflammation. Medications used for C3G and IC-MPGN can also cause itching, which may be a sign of an allergic reaction. Anaphylaxis is the most dangerous allergic reaction and is associated with facial swelling and wheezing — it requires immediate medical attention.

Treatments for Itching

Medical treatments for itching associated with kidney disease include topical medications (applied to the skin) as well as oral medications. Additionally, some medications may require a prescription from a healthcare provider. If you have a nephrologist (kidney doctor), they will likely be familiar with the itching associated with kidney disease and can help you find the right treatment options.

In some cases, seeing a dermatologist may be best. For example, if your skin symptoms go beyond itching or if you develop new skin lesions, a dermatologist’s expertise would be helpful. Additionally, if your itching hasn’t responded to treatments, a dermatologist may be able to provide a different treatment regimen catered more specifically to your symptoms.

Regardless of which provider you see, it’s important to determine whether your itching is related to your kidney disease. Itching unrelated to your kidney disease may require different treatment.

Below are some examples of ways to address your itchy skin.

Dialysis Modifications

If you are already on dialysis, dose adjustments may be an important first step. Your nephrologist can help make any needed changes, which may lower the amount of waste in your blood. This step may help improve your itching. While itching is associated with later-stage kidney disease, this symptom on its own is not typically a reason to start dialysis.

Treating Elevated Calcium, Parathyroid Hormone, or Phosphate

When your kidneys aren’t working well, calcium, parathyroid hormone, and phosphate can accumulate and cause itching. Oral treatments may be able to address high levels of these substances to reduce itching. Examples include vitamin D and cinacalcet, which reduce levels of parathyroid hormone and calcium.

Difelikefalin

Difelikefalin (Korsuva) is a medication approved by the U.S. Food and Drug Administration (FDA) specifically for treating CKD-aP for those undergoing hemodialysis. The medication is given during hemodialysis sessions and is not yet recommended for people undergoing peritoneal dialysis or those who are not on dialysis.

Other Treatments

There are many other options for treating itching associated with kidney disease. Some examples include:

• Oral antihistamines such as hydroxyzine
• Topical analgesics like pramoxine
• Nerve pain medications like pregabalin and gabapentin

Other treatment options that have more limited evidence for treating itching associated with kidney disease include:

• Phototherapy (treatment with lights at specific wavelengths)
• Supplements like omega-6 and omega-3 fatty acids, turmeric, and zinc
• The antidepressant sertraline

If you’re on dialysis, these treatments may be especially helpful if your nephrologist has already adjusted your dialysis dose.

Finally, if your healthcare provider doesn’t think your itching is related to kidney disease, they may recommend allergy testing or consider making changes to other medications you’re taking.

Home Care for Itching

Although over-the-counter and prescription medications can be helpful for itching, home care options are also recommended. Specifically, products that moisturize dry skin can help people with itching caused by kidney disease. This may be because chronic kidney disease can lead to changes in the sweat glands and oil glands of the skin, resulting in dry skin. In turn, dry skin can more easily become irritated and itchy. Avoiding frequent and very hot showers, using gentle soap, or nonsoap cleansers may help.

Emollients

An emollient softens and smooths the skin and is often found in most moisturizers. An emollient is considered a key component of CKD-aP treatment.

People living with kidney disease have varying degrees of dry skin. Therefore, even if your skin isn’t particularly dry, using an emollient could still help manage your itching.

You should use emollients on an ongoing basis, rather than only during itching flares. By incorporating emollients into your daily routine, you can keep your skin soft and smooth and help keep itching at bay.

If you have questions about how to care for your skin at home, ask your healthcare provider.

Talk With Others Who Understand

At MyKidneyDiseaseTeam, the site for people with rare kidney diseases and their loved ones, people come together to share their stories with others who understand life with rare kidney diseases.

Are you living with C3 glomerulopathy or immune complex membranoproliferative glomerulonephritis? Have you experienced itching? Which treatments or home care options were helpful? Share them in the comments below, or start a conversation by posting on your Activities page.