Regression of uraemic pruritus by cyclosporin treatment in a haemodialysis patient

Nephrology and Dialysis Unit 1Hospital of Chioggia, Venice 2San Paolo Hospital, Milan Italy Email: [email protected] Sir, Recent studies suggest that low dose (2.5–3.0 mg/kg daily) cyclosporin treatment is an effective, safe and well-tolerated treatment for atopic dermatitis which is refractory to conventional treatment modalities. This treatment can also lead to long-term remission of the disease in some patients [1]. Uraemic pruritus is a distressing disease that is difficult to treat. Its prevalence is high in the dialysis population. An effective treatment of severe uraemic pruritus is needed, as its consequences can be devastating for the patients. We describe the case of a 78-year-old woman who, at the end of 1999, 2 years after the beginning of haemodialysis, developed intense and generalized pruritus. Secondary hyperparathyroidism, dry skin, hyperphosphataemia, anaemia, peripheral neuropathy, high aluminium levels and hypervitaminosis A were all excluded. Although Kt/V was already satisfactory at 1.5, duration of dialysis was increased to 240 min, a more biocompatible membrane (polymethylmethacrylate) was used and swine heparin was changed with an EDTA-purified preparation. Other causes of pruritus (metabolic and endocrine diseases, biliary obstruction, myeloproliferative diseases, polycytaemia vera, iron deficient anaemia and cancer) were excluded.