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Dry skin is characteristic of relatively severe kidney failure, but is not particularly distressing as a symptom. Itching, however, is a common and sometimes very distressing symptom. It doesn't usually appear until loss of kidney function is severe (about 80 percent). Its cause is also unknown. Our study, summarized at the end of the chapter, suggests that both acidosis and anemia can contribute to itching. Itching may be confined to the torso or may be all over. Dietary treatment regularly reduces it, but in my experience does not usually eliminate it. This same complaint is common in patients on dialysis and is thought to be correlated with the concentration of plasma phosphate. We could not substantiate this finding in predialysis patients, but the marked elevation of serum phosphate concentration often seen in this group was not seen in this group.

Treatment for dry and itching skin is not very helpful for patients with kidney failure. Moisturizing preparations may decrease the itching somewhat. Antihistamines have been used with variable results. In severe cases, ultraviolet light treatments can be tried.

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