A Common Cause of Pruritus in Dialysis Patients
Article Outline
To the Editor:
The informative review of pruritus in chronic kidney disease (CKD) patients by Patel et al addresses a persistent, perplexing problem.1 The plethora of possible causes and solutions suggests a multifactorial etiology, but their paper failed to mention what I believe is a common cause of pruritus, much more common than the liver or endocrine disorders they cite. I have observed, in dialysis patients, the frequent association of pruritus with iron deficiency and the relief of pruritus with correction of iron deficiency. In 1988, I reported the first such cases.2 Earlier reports had described the association of pruritus and iron deficiency in non-CKD patients.3, 4, 5, 6 In the predialysis era, pruritus was reported in only 16% of CKD patients7 but was present in 78% to 85% of patients in the pre-erythropoietin dialysis era,8, 9 possibly reflecting an increased prevalence of iron deficiency which accompanied hemodialysis therapy. With the advent of erythropoietin therapy, iron deficiency has received greater attention, with iron measurement and parenteral iron administration now being routine. It is possible that any decrease in pruritus in recent years1 may reflect more routine use of parenteral iron and less iron deficiency in CKD patients.
Iron deficiency may be the most common readily treatable cause of significant pruritus in dialysis patients and should be recognized as a possible cause of pruritus in any patient, with or without CKD. Iron deficiency must be corrected before attributing pruritus solely to CKD.
Letters to the Editor may be in response to an article in AJKD or may concern a topic of interest to currentnephrology. For responses to AJKD articles, the Letter must be received no more than 6 weeks after the article’s date of print publication. The body of the letter should be as concise as possible and in general should not exceed 250 words. Up to 10 references and 1 figure or table may be included. There is no guarantee that letters will be published. Letters are subject to editing and abridgment without notice.
Letters should be submitted via AJKD’s online manuscript handling site, http://www.editorialmanager.com/ajkd. More information, including details about how to contact the editorial staff for assistance, is available in the journal’s Information for Authors.
Acknowledgements
Support: None.
Financial Disclosure: None.
References
- . An update on pruritus associated with CKD. Am J Kidney Dis. 2007;50:11–20(abstr)
- . Pruritus in dialysis patients due to iron deficiency. Kidney Int. 1988;33:226
- . The significance of low serum iron levels in the causation of itching. Proc. 12th Internatioinal Congress Dermotol, Munich. 1967;2:1061–1063
- . Nutrition and the skin: iron deficiency in dermatology. Proceedings of tenth symposium on advanced medicine In: London: Royal College of Physicians; 1974;p. 311–315
- . Iron deficiency pruritus. JAMA. 1978;239:1394
- Pruritus and severe iron deficiency in polycythemia vera. BMJ. 1982;285:91–92
- . Skin disease in non-surgical renal disease. Arch Dermatol Syphilol. 1932;26:314
- . Pruritus and hemodialysis. Arch Dermatol. 1974;109:107
- Clinical features of pruritus among patients undergoing maintenance hemodialysis. Arch Dermatol. 1982;118:154–156
PII: S0272-6386(07)01601-0
doi:10.1053/j.ajkd.2007.11.020
© 2008 National Kidney Foundation, Inc. Published by Elsevier Inc All rights reserved.
Refers to article:
- An Update on Pruritus Associated With CKD , 18 May 2007
- In Reply
