Management of chronic kidney disease associated pruritus: it's time to ask ‘do you itch?’

Prescribing information and adverse event reporting for Kapruvia®▾ (difelikefalin) can be found at the end of this article ((UK-DFK-2400065) April 2024) Itchy skin is a common symptom for people with advanced chronic kidney disease (CKD), and it has a significant impact on outcomes of treatment. Due to a combination of patient and healthcare related factors, it remains under-reported, under-diagnosed and inadequately treated. Recently, the landscape for treatment has changed. Although the pathogenesis of CKD-associated pruritus (CKD-aP) is complex and multifactorial, the role of the endogenous opioid pathway is now much better understood. Difelikefalin is a peripherally acting kappa opioid receptor agonist indicated for the treatment of moderate-to-severe pruritus associated with chronic kidney disease in adult patients on in-centre haemodialysis with a favourable safety profile; it does not produce typical opioid side-effects and is the first approved therapy for CKD-aP in Europe. People on dialysis should be asked ‘do you itch?’, and evidence-based management pathways should be used to treat this debilitating symptom much more effectively.