Promoting Excellence : Symptom Management Allgorythm for Chronic Kidney Disease

Renal Palliative Care Initiative: Symptom Management Allgorythm for Chronic Kidney Disease

This is a chart of commonly occurring symptoms experienced by patients of end stage renal disease, and recommended treatments.

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 chart was made available at the clinics and renal unit nursing stations.

esrd, end stage renal disease, 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. Ponticelli, C., Bencini, P.L., "Uremic Pruritis: A Review Nephron" 1992;60:1-5
  2. Roca, A.O., et al, "Efficacy of Quinine Versus Vitamin E" American Society for Artificial Internal Organs Journal, 1992; 38: M481-M485
  3. Lin, S et al, "Effect of Pramipexole in Treatment of Resistant Restless Legs Syndrome." Mayo Clinic Proc 1998 73:497-500
  4. Ponticelli, C., Bencini, P.L., Uremic Pruritis: A Review Nephron 1992;60:1-5
  5. Morton, C., Lafferty, M., Hau, C., Henderson, I., Jones, M. & Lowe, J. (1996). "Pruritis and skin hydration during dialysis." Nephrology, Dialysis, Transplantation, 11, 2031 2036.
  6. Giovanetti, S., Barsotti, G., Cupisti, A. (1995). "Oral activated charcoal in patients with uremic pruritus." Nephron, 70,193-196
  7. Schultz, B. & Roenigk, K. (1980). "Uremic pruritus treated with ultraviolet light." Journal of the American Medical Association
  8. Tapia, L, Cheigh, H., David, D. (1977). "Pruritus in dialysis patients treated with parenteral lidocaine." New England Journal of Medicine, 296, 261-262.
  9. Francos, G., Kauh, V.,Grittlen, S. (1991). "Elevated plasma histamine in chronic uremia effects of ketotifen on pruritus." International Journal of Dermatology, 30. 884-889.
  10. Silva S. et al, "Thalidomide for the Treatment of Uremic Pruritis: A Crossover Randomized Double-Blind Trial," Nephron, 1994:67:270-273
  11. Grattan, C.E.H., et al, "Plasmapheresis for Severe, Unremitting, Chronic Uticaria." Lancet, 1992;339:1078-1080
  12. Balaskas, E., Bamihas, G., Karamouzis, M., Voyiatzis, G. & Tourkantonis, A. (1998). "Histamine and serotonin in uremic pruritus: effect of ondansetron in CAPD-pruritic patients." Nephron, 78, 395-402
  13. Peer, G., Kivity, s., Agami, O., Fireman, E., Silverberg, D., Blum, M. & Ianina, A. (1996). "Randomized crossover trial of naltrexone in uraemic pruritus." Lancet, 348, 1552-1554
  14. Grattan, C.E.H., et al, "Plasmapheresis for Severe, Unremitting, Chronic Uticaria." Lancet,1992;339:1078-1080
  15. Bonomini, V., Coli, L., Scolari, M.P. "Profiling Dialysis: A New Approach To Dialysis Intolerance " Nephron, 1997;75:1-6
  16. Fang, J, Huang, C. "Midodrine in Patients on Hemodialysis with Chronic Hypotension Renal Failure," 1996;18:253-260
  17. Dheenan, S. et al, "Effects of Sertraline on Dialysis Hypotension." American Journal of Kidney Disease, 1998;31:624-630
  18. Boccanfuso, J.A. et al (2000). "The effects of megestrol acetate on nutritional parameters in a dialysis population." Journal of Renal Nutrition, 10, 36-43.

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Posted April 2004

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