Prurito urémico en el paciente en hemodiálisis: caso clínico

Case description: A complex and frail patient with end-stage chronic kidney disease developed severe, difficult-to-manage pruritus after 44 months on haemodialysis treatment.Description/evaluation of the care plan: Various drugs, techniques, and treatments were progressively implemented.Antihistamines were prescribed, and the patient underwent phototherapy sessions. Plasma exchange was also performed along with the administration of immunoglobulins, alternated with extracorporeal photopheresis sessions, showing limited effectiveness and worsening tolerance to pruritus. Additional treatments included potassium permanganate baths, corticosteroid infiltrations, monoclonal antibodies, and anticonvulsants, all without achieving the expected outcomes.The patient is currently undergoing haemodialysis with a prefilter haemoadsorption system.Close monitoring of skin integrity and prevention of infection risk were essential, both for scratching-related lesions and vascular access care. Nursing staff focused on providing comfort and recommended relaxation techniques. Moreover, psychological support was provided to address feelings of hopelessness. Currently, the patient continues to experience intermittent, difficult-to-control pruritus, significantly impairing quality of life.Conclusions: Uraemic pruritus is an underdiagnosed condition. Its distressing symptoms cause discomfort and impair the ability to perform activities of daily living. Proper evaluation using validated scales in clinical practice is necessary, along with a targeted and standardised treatment approach to achieve symptom control. Furthermore, improving the understanding of its pathophysiology and incorporating new therapies may provide relief and comfort for patients experiencing this condition.