Sequential Approach to the Uremic Patient with Pruritus 



Optimize dialysis adequacy 

Use biocompatible membranes for HD 

Optimize nutrition 



Patient education - Break scratch-itch cycle: 

 - apply cold cloths or 

 - exert pressure on itching region 



Emollients 

Antihistamines 



Capsaicin 0.025% cream; 

ultraviolet B therapy; 

oral activated charcoal'; 

long-chain essential tatty acids* 



Gabapentin 100-300 mg orally after dialysis 

Nalfurafine 5 mg orally per day 

Thalidomide 100 mg daily—patients beyond reproductive age (max. 3 months) 

Consider serotonin antagonists, naltroxono, tacro imus ointment, kototifen



Sequential Approach to the Patient with Pruritus 



#Uremic #Uremia #Pruritis #Management #Sequential #Algorithm #Nephrology