Skin Problems and Dialysis

Some patients with chronic kidney disease (CKD) who are on dialysis may notice some unpleasant changes in their skin. Three skin conditions that sometimes affect those on dialysis include itching (pruritus), dry skin (xerosis) and skin discoloration (hyperpigmentation). Learning why these skin conditions happen, and what can be done to prevent or ease the problem, can help keep skin as healthy as possible.

Itching (pruritus)

A majority of dialysis patients, whether they do hemodialysis or peritoneal dialysis (PD), may experience itching at some point. Some feel itchy all the time, while for others it comes and goes. Many say itching is worse during or just after treatment. For some people the itching is in one area, while others feel itchy all over.

A common cause of itching is a high level of phosphorus in the body. Because dialysis doesn't effectively remove phosphorus, a renal diet that limits foods high in phosphorous is prescribed. Additionally, taking phosphorus binders with every meal and snacks can help. Try to maintain a phosphorus level at 5.5 or less. Staying on dialysis for your full treatment time is also recommended, because it can remove some phosphorus as well as other wastes and toxins.

Allergies can cause itching. If you notice itching occurs at the beginning of dialysis treatments, you could have an allergy to the blood tubing, dialyzer (artificial kidney), the type of heparin being used or other elements associated with the treatment.

Antihistamines, such as Benadryl, are used to treat allergies and have helped to relieve itching. Creams that contain capsaicin, witch hazel, lanolin or camphormay also relieve itching. Some people report that getting sunlight or ultraviolet (UV) light treatments in a doctor's office or treatment center helps lessen itching.

Check with your doctor before trying any anti-itch method or product.

Dry skin (xerosis)

Dry skin is also a common condition for patients with end stage renal disease (ESRD). Kidney failure may make changes in the sweat glands and oil glands, which causes the skin to dry out. Dry skin can lead to infections and can cause skin wounds to heal slower than they should. Dry skin can also cause itching.

To prevent or treat dry skin, avoid long, hot showers or baths. Also, look for soaps that have natural, pure ingredients without harsh perfumes and chemicals. A moisturizing soap for sensitive skin can be a good choice. There are also bath products made with oatmeal created for dry, itchy skin that can be found at drug stores.

Apply a moisturizing, high-water content gel, lotion or cream to the body right after bathing, while the skin is still damp. Avoid creams or lotions with alcohol. Ask your doctor or pharmacist about dry skin treatments that are available.

Skin discoloration

Many reported cases of discolored skin, or hyperpigmentation, happen to people with ESRD. One cause of skin discoloration is related to pigments called urochromes being retained in the skin. Normally these are excreted by healthy kidneys. Patients with this condition tend to have a grayish, almost metallic color skin.

Another discoloration is called uremic frost. This is a white, powdery substance left on the skin surface after sweat dries. Uremic frost is prevented by getting adequate dialysis.