Decoding Itch in CKD: From CKD-aP Suspicion to Solution

Improving Sleep and Mental Health in Patients with CKD-aP

Transcript

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Dr. Manenti:
This is CME on ReachMD, and I'm Dr. Lucio Manenti. Here with me today is Dr. Leonie Kraft. Leonie, nice to see you. And the question is about patients with CKD-aP that struggle not only with itch, but also with sleep, depression, and other issues known as symptom clusters.

Leonie, let's review how CKD-aP symptom clusters manifest through a real-world patient case study.

Dr. Kraft:
Thank you, Lucio. I think that's a really important point you bring up. And I want to share a real patient case I had a couple of years ago, and he was one of the patients we started DFK really early on. He was on dialysis for 2 months before he developed itch. He was 80 years old, and on the physical side, he had severe scratch marks on his skin, arms, legs, and his torso.

But there was also a sentence he said back then to me that has stayed with me, and I think that captures the impact CKD-aP has on our patients. First, he said, “My medical history was nowhere near as bad as this itch.” And I mean, he was an 80-year dialysis patient. We all know that he probably had a complex medical history, which he had, and he also said, “I don't go out anymore, I don't sleep, and I don't enjoy my favorite show.”

And this is just a classic example of symptom cluster—itch leads to sleep disturbance, mood decline, social isolation. And all that goes beyond the skin and just deeply affects the quality of life of our patients.

And with this patient, we started DFK pretty soon after it became available in Germany, but his response was not immediate, so it took him a couple of weeks till he showed a response. And he even thought about stopping dialysis altogether because of the severity of his symptoms. And we also discussed discontinuing DFK, but because we didn't have any other good option, we continued.

And after 11 weeks was the first time he came in the morning to dialysis, and he said, “I slept so much better tonight. I don't think I scratched my skin, but the sleep is so much better.” And he experienced meaningful relief and improved sleep after 11 weeks.

But I just want to make it clear, 11 weeks is not a normal time for a response for most patients. Over 60% of the patients who respond do so after 4 weeks, and most of the patients, over 90%, respond after 8 weeks. But it is still important to give our patients enough time to respond, and there's always this odd one out, so we continue for 12 weeks till we determine nonresponse for our patients.

And I think another question that we keep asking ourselves—and you and Emilio already addressed this—is can we discontinue DFK eventually when the patient shows a response? And in our patient case, we unintentionally answered this question because we once forgot to order the medication. And this was a couple of years ago, so it was harder to access DFK, and his symptoms returned with full force. He had a WI-NRS from 8 to 9 again. And only after we started DFK again did he stop scratching his skin and showed a meaningful relief.

We also have good real-world data from, I think, over 600 US patients that show this, that when patients discontinue DFK, they experience a rise in the itch score again.

And I think I want to let you go with a quote from this patient. I asked him again a couple of weeks ago how his itch is, and he said, “I don't think about the itch.”

And I think this is so impressive for a patient who spent his days and his nights thinking about nothing else than itching, and for him to not think about it is just a huge accomplishment for all of us.

Dr. Manenti:
Well, this has been a good discussion, but our time is up. Thanks for listening.

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Overview
Despite its prevalence, chronic kidney disease–associated pruritus (CKD-aP) remains underrecognized and undertreated in patients undergoing hemodialysis, owing to its complex pathophysiology, diagnostic challenges, symptom cluster etiology, and multidimensional impact on quality of life. Learn best practices from the experts, including how to use validated tools and structured approaches for assessing CKD-aP severity, and evidence-based, patient-centered treatment strategies. Using real-world case reviews, explore the value of multidisciplinary care, communication, and shared decision-making to address the physical and psychosocial complexities of CKD-aP.
Disclosure of Relevant Financial Relationships
In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative (GLC) requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any ineligible company. GLC mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Faculty:
James Burton, DM, FRCP
Professor of Renal Medicine
University Of Leicester
Leicester, United Kingdom

Dr. Burton has reported the following relevant financial relationships or relationships with ineligible companies of any amount during the past 24 months:
Consulting Fees: A. Menarini, AstraZeneca, Boehringer Ingelheim, CSL Vifor, Diaverum

Leonie Kraft, MD
Department of Internal Medicine and Nephrology
Robert-Bosch-Hospital Stuttgart
Stuttgart, Germany

Dr. Kraft has reported the following relevant financial relationships or relationships with ineligible companies of any amount during the past 24 months:
Consulting Fees: AstraZeneca, CSL Vifor

Lucio Manenti, MD, PhD
Nephrology Unit
Azienda Ospedaliero-Universitaria di Parma
Parma, Italy

Dr. Manenti has reported the following relevant financial relationships or relationships with ineligible companies of any amount during the past 24 months:
Consulting Fees: CSL Vifor

Jose Emilio Sánchez, MD, PhD
Head, Nephrology Departament
Hospital Universitario Central de Asturias
Oviedo, Spain

Dr. Sánchez has no relevant relationships to disclose.

Reviewers/Content Planners/Authors:
Cindy Davidson has no relevant relationships to disclose. 
Brian P. McDonough, MD, FAAFP, has no relevant relationships to disclose. 
Katie Sheridan, PhD, has no relevant relationships to disclose.
Learning Objectives
Upon completion of this activity, learners should be better able to:
Describe the epidemiology, pathophysiologic mechanisms, and multidimensional impact of CKD-associated pruritus (CKD-aP) in patients receiving hemodialysis
Assess CKD-aP severity and impact using validated tools, including the WI-NRS, 5D-Itch, and patient-reported outcome measures (PROMs), as part of a systematic diagnostic approach
Develop patient-centered, multidisciplinary management strategies that address physical symptoms and improve quality of life (QoL) in patients with CKD-aP
Implement strategies that address the biopsychosocial burden of CKD-aP through patient-centered communication and coordinated multidisciplinary care
Target Audience
This activity has been designed to meet the educational needs of nephrologists, nephrology advanced practice providers, dermatologists, and dermatology advanced practice providers, as well as all other physicians, physician assistants, nurse practitioners, nurses, pharmacists, and healthcare providers involved in managing patients with CKD-aP.
Accreditation and Credit Designation Statements
In support of improving patient care, Global Learning Collaborative (GLC) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team. 

Global Learning Collaborative (GLC) designates this enduring activity for a maximum of 1.0AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Global Learning Collaborative (GLC) designates this activity for 1.0 nursing contact hour(s). Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Global Learning Collaborative (GLC)/AXIS Medical Education designates this activity for 1.0 contact hour/0.1 CEUs of pharmacy contact hour(s).

The Universal Activity Number for this program is JA0006235-0000-25-091-H01-P. This learning activity is knowledge-based. Your CE credits will be electronically submitted to the NABP upon successful completion of the activity. Pharmacists with questions can contact NABP customer service (custserv@nabp.net). 

Global Learning Collaborative (GLC) has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit(s) for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credit(s). Approval is valid until October 24, 2026. PAs should claim only the credit commensurate with the extent of their participation in the activity.
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Our ultimate goal is to improve the care being delivered to patients, and our high-quality, evidence-based CME initiatives reflect our dedication to the creation and execution of excellence and are the product of shared research, knowledge, and clinical practice skills across the healthcare continuum.
Commercial Support
This activity is supported by an independent educational grant from CSL Vifor.
Disclaimer
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of GLC and Medtelligence. This presentation is not intended to define an exclusive course of patient management; the participant should use his/her clinical judgment, knowledge, experience, and diagnostic skills in applying or adopting for professional use any of the information provided herein. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Links to other sites may be provided as additional sources of information. Once you elect to access a site outside of Medtelligence you are subject to the terms and conditions of use, including copyright and licensing restriction, of that site. 

Reproduction Prohibited 
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System Requirements
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Publication Dates
Release Date: 10/24/2025
Expiration Date: 10/24/2026