Itching

[RainingRoses]

I 'm a newbit to this board but not to dialysis.  I searched your archives and didn't find this question answered.  I have acceptable phosphorus levels, but persistent itching (like sheet lighting under the skin that is a cross between itching, electric shock, and stinging.  An internet search revealed that noone really knows why dialysis patients itch.  Some say, of course, high phosphorus.  Another theory--high PTH--which seems to be the culprit for me.  Anyone else have this experience?  My neph lowered my PTH meds because he said the PTH level was "normal" which is too low for a dialysis patient.  Made no sense to me.  As the PTH crept upwards, so did the itching.  I'll see him next week, and I don't want him to dismiss my research.  I do want him to get my PTH lower again.  Also, I ordered a new product for itching.  IF (big "if") it works, I'll share.
Pete in Atlanta

[billybags]

Hi RainingRose, I think most real patients suffer with itching from time to time and yes it is one or the other, phos or pith. My husband drove me mad at one time with his constant "give my back a scratch" I felt like a  monkey does when it is scratching its baby.Thank goodness he hasn't had it for a while. let us know about the product.

[Stoday]

A renal itch feels different from normal itches. I like RainingRoses' description; I think it's like little pinpricks with pins from underneath the skin.

I'll be interested to hear about the fix. I supress my itching by stripping off and laying on top of my bed with cold air from the A/C blowing over me. But that can be a bit inconvenient.

[looneytunes]

Stoday...yes, I can imagine times when that solution just may not work.   

Roses, hubby suffered so much from the itching and scratching that he is covered with scars from the spots breaking open and bleeding.  The culprit seemed to be high PTH which the neph finally began treating with Zemplar.  His Phos was in the normal range for the longest time but PTH remained high.  Until we started with the Zemplar. Now the itching seems to have subsided and he is not bleeding all over our bedding. 

Hope that helps. 

[AIRon]

I have had this problem with itching. It was caused by the filter they were using on me, it was a disposable unit and I was getting a reaction to it, and also I was becoming nauseated too. So they put me on a larger reusable filter and I have had no problems with itching or anything else for at least 3 weeks now. The itching did feel like pin pricks and it was all over and it drove me nuts, I hope this helps but we are all different, and a lot of things effect a lot of people in a lot of strange ways.

[RightSide]

Hi RainingRoses,

In my case, much of the itching seemed to be due to my high PTH.  Because my phosphorus level was never high.

When treatment with Zemplar brought my PTH down to the "normal" range expected for hemodialysis patients, much of the itching subsided.  But not all, as I'll explain shortly.

A third cause of itching is high calcium levels in the blood. So the first best way to treat itching is to bring all three--calcium, phosphorus, and PTH--into "normal" ranges.

But you're right that there are still other causes of itching, particularly uremic neuropathy--nerve damage from the kidney failure.  This can produce an odd prickling or "pins-and-needles" sensation, or itching, or tingling, or all three.  What you're describing sounds very much like that.

While the classic name for this is "uremic neuropathy," there are other chemicals that can cause it besides urea.  Notably those "advanced glycation end products" that I posted about elsewhere--chemical byproducts of cooking that in ESRD patients can build up to toxic levels.

I suffered from this neuropathy problem too, for which my neph prescribed Neurontin (gabapentin), 300 mg/day.  That seems to have helped greatly.

So once your calcium, phosphorus and PTH are all brought under control, if you're still having problems, maybe you should ask your neph about trying Neurontin.

Finally, there's a reason your neph doesn't want your PTH to fall down to levels that are typical for healthy folks who don't have kidney disease.  It's been found that PTH levels that low in ESRD patients lead to another problem, called adynamic bone disease:  The bone (which is living tissue) stops remodeling altogether, which leads to bone weakening and even fractures.  IOW, you can get some of the same problems you would get if PTH levels are too high (called secondary hyperparathyroidism).

So we ESRD patients have to thread a needle between PTH too high (secondary hyperthyroidism) and PTH too low (adynamic bone disease).  The window is narrow:  between 100 and 300.

[Zach]

While the classic name for this is "uremic neuropathy," there are other chemicals that can cause it besides urea.  Notably those "advanced glycation end products" that I posted about elsewhere--chemical byproducts of cooking that in ESRD patients can build up to toxic levels.

I suffered from this neuropathy problem too, for which my neph prescribed Neurontin (gabapentin), 300 mg/day.  That seems to have helped greatly

Also, consumption of too much Vitamin B₆ can cause peripheral neuropathy.

[RainingRoses]

So we ESRD patients have to thread a needle between PTH too high (secondary hyperthyroidism) and PTH too low (adynamic bone disease).  The window is narrow:  between 100 and 300.

RightSide,
Thank you for so much info!  I'm surprised that my research hasn't found all this info in one place, but I truly appreciate your taking the time to share.  I'm feeling more positive already!
Pete in Atlanta

[Phil]

I have Alports too......before I started dialysis I had major itching problems...getting to sleep was a major problem....I would have to have a boiling shower, put cream, and take some lexotan drops before I could relax!!! After 2 weeks of dialysis the itching has gotten considerably better....not gone...but much better than before!

[RightSide]

RightSide,
Thank you for so much info!  I'm surprised that my research hasn't found all this info in one place, but I truly appreciate your taking the time to share.  I'm feeling more positive already!
Pete in Atlanta

You're very welcome!

In your own research, did you check out eMedicine from WebMD?  There you will find this helpful article:

http://emedicine.medscape.com/article/1098029-overview

As you will see from that article, itching can occur from a variety of triggers, and it's suspected that more exist which are currently unknown.

One thing I forgot to mention to you was that UV-B (Ultraviolet-B light) therapy has also proven helpful in relieving some kinds of itching.  Seeing that eMedicine article once more reminded me of it.

The kind of itching you're talking about (combined with electrical-like tingling) really does sound like neuropathy.  Discuss it with your neph and ask him if Neurontin might help you.  It sure helped me.