Treatment for common symptoms of Kidney Disease

What are the treatment options for common symptoms of Kidney Disease?

A variety of treatment options exist with a wide spectrum in the quality of the underlying evidence.

Here is the table with a summary of the general approach to three common symptoms that affect nephrology patients.

Approaches to Address Symptoms Associated With Kidney Disease

FatigueEvaluate for common conditions such as anemia, hypothyroidism, severe hyperparathyroidism, depression, malnutrition, sleep disturbances, or hypotension.Perform a careful medication reviewAdverse drug reactions (especially from antihypertensives) are common.Consider adjustments to the dialysis prescription.This may include changes to shift timing, treatment duration, and treatment frequency.
PruritusEvaluate for common conditions such as uremia, hyperphosphatemia, hypercalcemia, hyperparathyroidism, dry skin, contact dermatitis, anemia, or drug sensitivity/allergies.Skin care measures includeMinimizing use of harsh soaps and fragrancesUse of topical emollientsAvoidance of hot water during bathing or showeringUse of humidifiers in winter seasonsPotential pharmacologic therapies include:Low-dose gabapentinPhototherapyTopical camphor or mentholDermatologic consultation may be needed for select patients
PainAssess for description of pain; whether the pain is episodic or constant; and whether the duration is expected to be acute or chronicDistinguish pain from dialysis associated crampingDetermine whether pain is thought to be nociceptive or somatic (or both)Analgesics should target appropriate pain typeIndividualized plan for analgesic selection based on age and comorbiditiesInquire about ongoing psychosocial distress, depression, anxiety, sleep complaints, or labile moodIf present, addressing these first may be beneficialConsideration can be given to nonopioid treatments and nonpharmacologic measures such as mild to moderate exercise or cognitive behavioral therapyUse of opioids should be used if other measures failWith proper assessment of risk for misuse, opioids can be safely used in dialysis patientsOpioids safe in dialysis patients include fentanyl and methadone. Hydromorphone and oxycodone can be used though doses should start low with longer time intervals between doses (e.g., every 6–8 h as needed instead of every 4 h).

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