Itching is a common symptom among patients with end-stage chronic kidney failure undergoing hemodialysis. Persistent itching often leads to sleep loss, skin abrasions from scratching, and significantly impacts quality of life.

Doctor of Medicine II Ho Tan Thong, from the Nephrology - Dialysis Unit at Tam Anh General Clinic District 7, stated that itching in dialysis patients is not merely a skin manifestation but often linked to various internal body disorders. As kidney function declines, accumulated toxins alongside metabolic disturbances such as hyperphosphatemia, calcium imbalance, hyperparathyroidism, chronic inflammation, and dry skin can stimulate nerve endings under the skin, causing persistent itching. Additionally, some cases are associated with suboptimal dialysis efficacy or medication side effects.

Doctor Thong examining a patient undergoing dialysis. Illustration: *Tam Anh General Clinic District 7*.

To improve persistent itching, patients should note the following:

Complete and timely dialysis

Patients must adhere to their dialysis schedule, refraining from skipping sessions or shortening dialysis duration, as this can lead to greater accumulation of toxins and worsen itching symptoms.

At Tam Anh General Hospital, online hemodiafiltration (HDF Online) technology, which combines diffusion and convection, also helps alleviate itching symptoms in some patients. HDF Online effectively removes medium and large-sized molecules that are difficult to eliminate with conventional hemodialysis, thereby reducing itching while contributing to a decrease in chronic inflammation and limiting cardiovascular complications.

Diet and medication adherence

Hyperphosphatemia is a common cause of itching in kidney failure patients. Therefore, patients must follow dietary guidelines from doctors and nutritionists, limiting phosphorus-rich foods such as organ meats, carbonated soft drinks, processed foods, and certain nuts.

If prescribed phosphorus binders, patients must take them at the correct time and dosage, while also effectively controlling calcium, phosphorus, and parathyroid hormone levels to improve itching symptoms and limit bone and cardiovascular complications.

Patients should not self-medicate with anti-allergy drugs or topical medications without a doctor's prescription. In reality, itching caused by kidney failure does not always respond to antihistamines. Depending on the cause, doctors may prescribe neuromodulators, hyperparathyroidism control medications, or other treatments to improve symptoms.

Proper skin care

Dialysis patients often have drier skin than normal, which intensifies the sensation of itching. Patients should use fragrance-free moisturizer immediately after showering and reapply one to two times daily if their skin is dry.

When showering, use moderately warm water, avoiding excessively hot water as it can strip the skin's natural protective oils. Opt for mild shower gels free of harsh detergents to minimize irritation. Wear loose-fitting, soft cotton clothing and maintain a cool, airy living environment to reduce skin irritation.

During intense itching, avoid vigorous scratching to prevent skin abrasions, bleeding, and an increased risk of infection, especially in kidney failure patients who have compromised immunity.

Doctor Thong advises that if itching persists for several weeks, causes sleep loss, affects daily activities, or if signs such as extensive skin abrasions, bleeding, infection, or unusual rashes appear, patients should seek medical examination. This is because these could indicate ineffective dialysis or a metabolic disorder requiring adjustment.

Dinh Lam