The Itch

Ian's world had become a torment of relentless itching. It wasn't the seasonal sniffles or the occasional rash he'd known as a child; this was a deep, maddening itch that seemed to originate from the very core of his being, a cruel companion to his kidney disease. He'd scratched until his skin was raw, leaving angry red welts that only added to his misery. Sleep was a distant memory, and his once-vibrant life had shrunk to a cycle of discomfort and frustration.

Driven to desperation, Ian scheduled appointments with his nephrologist and dietician, determined to uncover the source of his suffering.

Here's a breakdown of what Ian was dealing with, and what he and his medical team could do:

Understanding the Itch (Pruritus)

• Kidney Disease and Toxins:
  • The primary suspect was uremic pruritus, a common and distressing symptom of chronic kidney disease (CKD). Damaged kidneys struggle to filter waste products, and the buildup of these toxins in the bloodstream can trigger intense itching.
  • Specifically, the build up of things like phosphorus, and other uremic toxins.
• Dry Skin:
  • Kidney disease can also lead to dry skin (xerosis), which exacerbates itching.
• Other Potential Factors:
  • High parathyroid hormone levels.
  • Imbalances in calcium and phosphorus.
  • Nerve damage.
  • Immune system imbalances.

What Ian Did and Needs to Do:

• Seeking Medical Help:
  • Ian's decision to consult his nephrologist and dietician was crucial. They could assess his condition, rule out other potential causes, and develop a tailored treatment plan.
• Detailed Symptom Reporting:
  • Ian needed to provide his medical team with a comprehensive account of his itching, including:
    • When it started.
    • How often it occurred.
    • The intensity of the itching.
    • Any triggers or aggravating factors.
• Dietary Review:
  • The dietician would review Ian's diet, paying close attention to phosphorus intake. Dietary modifications could help regulate mineral levels and alleviate itching.
• Medication Review:
  • His doctor would need to review all of his medications, as some can cause itching as a side effect.
• Skin Care:
  • Gentle skin care is essential. Ian needed to avoid harsh soaps and hot water, and moisturize his skin frequently with fragrance-free emollients.
• Possible Medical Interventions:
  • His doctor might prescribe medications to alleviate itching, such as:
    • Gabapentin or pregabalin (for nerve-related itching).
    • Medications to control phosphorus levels.
    • Kappa-opioid agonists.
    • Topical creams.
• Dialysis adjustments:
  • If Ian is on dialysis, his dialysis team may adjust the dialysis schedule, or dialysis prescription to better remove the waste products that are causing the itching.

What Ian Needs to Stop:

• Excessive Scratching:
  • While it's difficult to resist, scratching only worsens the problem, leading to skin damage and potential infections.
• Using Harsh Skin Products:
  • Ian needed to avoid soaps, lotions, and detergents with fragrances or harsh chemicals.
• Taking Hot Showers/Baths:
  • Hot water dries out the skin, which will make the itching worse. Lukewarm or cool water is recommended.

Finding Relief:

Ian's path to relief would involve a collaborative effort between him and his medical team. By addressing the underlying causes of his itching and implementing appropriate management strategies, he could regain control of his comfort and quality of life.