Promoting Excellence : Treatment Protocol for Pruritis in ESRD

Renal Palliative Care Initiative: Treatment Protocol for Pruritis in ESRD

This treatment protocol was created to address and manage occurrence of pruritis in patients with end stage renal disease.

Clinical Care Tools - Symptom Management

Renal Palliative Care Initiative
Baystate Medical Center
759 Chestnut Street S2669
Springfield, MA 01199

Michael Germain, M.D.
[email protected]

How the grantee used this instrument:
This protocol was made available at the clinics and renal unit nursing stations.

esrd, end stage renal disease, pruritis, dialysis, kidney disease, symptom assessment

To use this tool:
You may print and copy this tool for your own use from this site. Please credit source.


  1. Mettang, T, Fritz, P, Weber, J, et al. "Uremic prutitius in patgients on heomdialysis or continuous ambulatory peritoneal dialysis: The role of plasma histamine and skin mast cells." Clinical Nephrology, 1990; 34:136.
  2. Hampers, CL, Katz, AI, Wilson, RE, Merrill, JP. "Disappearance of uremic itrching after subtotal parathyroidectomy." New England Journal of Medicine, 1968; 279:695.
  3. Cawley, IP, Hoch-Ligeti, C, Bond, GM. "The eccrine sweat glands of patients in uremia." Arch Dermatol, 1961; 84:51.
  4. Massry, SG, Popovtzer, MM, Coburn, Jw, et al. "Intractable pruritus as a manifestation of secondary hyperparathyroidism in uremia." New England Journal of Medicine, 1968; 279:697.
  5. Parfitt, AM, Massry, SG, Winfield, AC, et al. "Disordered calcium and phosphorus metabolism during maintenance hemodialysis." American Journal of Medicine, 1971; 51:319.
  6. Blachley, JD, Blankenship, M, Menter, A, ET AL. "Uremic prutitus: Skin divalent ion content and response to ultraviolet therapy." American Journal of Kidney Diseases, 1985; 5:237.
  7. Hiroshige, K, Kabashima, N, Takasugi, M, Kuroiwa, A. "Optimal dialysis improves uremic pruritis." American Journal of Kidney Diseases, 1995; 25:413.
  8. De Marchi, S, Ceddhin, E, Villaltgra, D, et al. "Relief of pruritis and decreases in plasma histamine concentrations during erythropoietin therapy in patients with uremia." New England Journal of Medicine, 1992; 326:969.
  9. Kessler, M, Moneret-Vautrin, DA, Cao-Huu, T, et al. "Dialysis pruritis and sensitization." Nephron, 1992; 12:330.
  10. Robertson, K, & Mueller, B. "Uremic pruritis." American Journal of Health-System Pharmacy, 1996; 53:2159.
  11. Peer, G, Kivity, S, Agami, O, et al. "Randomised crossover trial of naltrexone in uraemic pruritis." Lancet, 1996;348: 1552.
  12. Silva, S.R.B., Vianna,P.C.F, Lagon, N.V., et al. "Thalidomide for the Treatment of Uremic Pruritis: A Crossover Randomized Double-Blind Trail." Nephron, 1994;67:270-74
  13. Tarng, DC, et al. "Hemodialysis-related pruritis: a double-blind, placebo-controlled, crossover study of capsaicin 0.025% cream." Nephron, 1996; 72:617.
  14. Balaskas, E, Bamihas, G, Karamouzis, M, et al. "Histamine and serotonin in uremic pruritis: effect of ondansetron in CAPD-pruritic patients." Nephron, 1998; 78:395.
  15. Francos, G, Kauh, V, Grittlen, S, "Elevated plasma histamine in chronic uremia: effects of ketotifen on prutitus." International Journal of Dermatology, 1991; 30:884.
  16. Silverberg, D, Ianina, A, Reisin, E, "Cholestryramine in uraemic pruritis." British Medical Journal, 1997; 1:752.
  17. Giovanetti, S, Barsotti, G, Cupisti, A, "Oral activated charcoal inpataients with uremic pruritis." Nephron, 1995; 70:193.
  18. Schultz, B, & Roenigk, K, "Uremic pruritus treated with ultraviolet light." Journal of the American Medical Association, 1980; 243:1836.

To view this tool:
Left click on the download link to view the PDF document in your Web browser. Right-click on the download link to save the document to your computer.
pdf PDF 77 KB / 2 pages (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)

Posted April 2004

Baystate Medical Center overview page

# BMC11, type:symptom_management

Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit for more resources.

Promoting Excellence logo and link to home page