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Pruritus and Aromatherapy Associated with Chronic Kidney Disease

Year 2025, Volume: 20 Issue: 2, 139 - 146, 31.05.2025
https://doi.org/10.47565/ndthdt.2025.106

Abstract

Chronic kidney disease, a common disease worldwide, is characterised by persistent deterioration of kidney function. Dermatological issues such as pruritus and xerosis, frequently observed in this condition, significantly impair patients’ quality of life and complicate the treatment process. The pathophysiology of pruritus involves factors such as peripheral neuropathy, immune system imbalances, opioid receptor dysregulation, the activation of non-histaminergic itch pathways due to the accumulation of uremic toxins in the skin, microinflammation, and xerosis. In addition to pharmacological treatments, non-pharmacological methods, particularly aromatherapy, are increasingly being utilized to manage pruritus. Essential oils such as lavender, violet, chia seed oil, and many others are applied topically, through massage, or inhalation to alleviate symptoms of pruritus and xerosis. Existing literature suggests that aromatherapy may be effective in reducing skin symptoms and pruritus. However, to establish the efficacy and safety of this therapeutic approach, more comprehensive studies are required, focusing on the standardization of application protocols and the evaluation of the effectiveness of various essential oils. Assessing the effects of aromatherapy through comparative clinical trials with larger sample groups is crucial for enhancing the evidence base in this area.

References

  • theisn.org. [Internet] International Society of Nephrology. ISN–Global Kidney Health Atlas. 2023(Internet). 2023[cited 2024 Oct 11]. Available from: www.theisn.org/global-atlas
  • hsgm.saglik.gov.tr [Internet]. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Türkiye Böbrek Hastalıkları Önleme ve Kontrol Programı. 2018[cited 2024 Oct 11]. Available from: https://hsgm.saglik.gov.tr/depo/birimler/kronik-hastaliklar-ve-yasli-sagligi db/Dokumanlar/Kitaplar/Turkiye_Bobrek_Hastaliklari_Onleme_ve_Kontrol_Programi_2018-2023.pdf
  • Varol E, Sivrikaya SK. Kronik böbrek yetmezliğinde yaşam kalitesi ve hemşirelik. J DU Health Sci Inst (Internet). 2018[cited 2024 Oct 11];8(2):89–96. Available from: https://dergipark.org.tr/tr/download/article-file/504947
  • Tayaz E, Koç A. Hemodiyaliz tedavisi alan kronik böbrek yetmezliği hastalarında semptom yönetimi ve hemşirelik. JANHS [Internet]. 2020[cited 2024 Oct 11];23(1):147–56. Available from: https://dergipark.org.tr/tr/download/article-file/1013655
  • Rashpa R, Mahajan V, Kumar P, Mehta K, Chauhan P, Rawat R, et al. Mucocutaneous manifestations in patients with chronic kidney disease: A cross-sectional study. Indian Dermatol Online J. 2018;9(1):20-6. https://doi.org/10.4103/idoj.IDOJ_160_17
  • Tajalli F, Mirahmadi SMS, Mozafarpoor S, Goodarzi A, Nasiri Partovi M, Lakestani D. Mucocutaneous manifestations of patients with chronic kidney disease under hemodialysis: A cross-sectional study of 49 patients. Dermatol Ther. 2021;34(4):e15015. https://doi.org/10.1111/DTH.15015
  • Engler F, Kerschbaum J, Keller F, Mayer G, Antlanger M, Edlinger R, et al. Prevalence, patient burden and physicians’ perception of pruritus in haemodialysis patients. Nephrol Dial Transplant. 2024;39(2):277–85. https://doi.org/10.1093/ ndt/gfad152
  • Wulczyn KE, Steele DJR. One-year pruritus trends among patients receiving hemodialysis and associated outcomes. Am J Kidney Dis. 2023;82(6):647–9. https://doi.org/10.1053/j.ajkd.2023.08.004
  • Sukul N, Karaboyas A, Csomor PA, Schaufler T, Wen W, Menzaghi F, et al. Self-reported pruritus and clinical, dialysis-related, and patient-reported outcomes in hemodialysis patients. Kidney Med. 2021;3(1):42-53. https://doi.org/10.1016/ j.xkme.2020.08.011
  • Orasan OH, Muresan F, Mot A, Sitar Taut A, Minciuna I, Coste SC, et al. Hemodialysis patients with pruritus and ınsomnia have ıncreased risk of death. Blood Purif. 2020;49(4):419–25. https://doi.org/10.1159/000505147
  • Schricker S, Kimmel M. Unravelling the pathophysiology of chronic kidney disease-associated pruritus. Clin Kidney J. 2021;14(3):23–31. https://doi.org/10.1093/ckj/sfab200
  • Lipman ZM, Paramasivam V, Yosipovitch G, Germain MJ. Clinical management of chronic kidney disease-associated pruritus: current treatment options and future approaches. Clin Kidney J. 2021;14(3):16–22. https://doi.org/10.1093/ckj/sfab167
  • Hu X, Sang Y, Yang M, Chen X, Tang W. Prevalence of chronic kidney disease-associated pruritus among adult dialysis patients. Medicine. 2018;97(21):e10633. https://doi.org/10.1097/MD.0000000000010633
  • Kazak A, Özkaraman A. Üremik pruritus ve hemşirelik yönetimi. CBU-SBED. 2020;7(3):408–12. https://doi.org/10.34087/CBUSBED.695705
  • Manenti L, Leuci E. Do you feel itchy? A guide towards diagnosis and measurement of chronic kidney disease-associated pruritus in dialysis patients. Clin Kidney J. 2021;14(3):8–15. https://doi.org/10.1093/ckj/sfab143
  • Şahin A, Sarıtaş SÇ, Soylu A. Üremik kaşıntıda kullanılan tamamlayıcı sağlık yaklaşımları. NefroHemDergi. 2020;15(2):96–103. https://doi.org/10.47565/NDTHDT.2020.11
  • Kavurmacı M, Tan M. Üremik kaşıntı ve hemşirelik bakımı. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2015;18(1):57–62. https://doi.org/10.17049/AHSBD.82817
  • Cheng AY, Wong LS. Uremic pruritus: from diagnosis to treatment. Diagnostics (Basel). 2022;12(5):1108. https://doi.org/10.3390/DIAGNOSTICS12051108
  • Topf J, Wooldridge T, McCafferty K, Schömig M, Csiky B, Zwiech R, et al. Efficacy of difelikefalin for the treatment of moderate to severe pruritus in hemodialysis patients: pooled analysis of KALM-1 and KALM-2 phase 3 studies. Kidney Med. 2022;4(8):100512. https://doi.org/10.1016/j.xkme.2022.100512
  • Ko MJ, Peng YS, Wu HY. Uremic pruritus: Pathophysiology, clinical presentation, and treatments. Kidney Res Clin Pract. 2023;42(1):39–52. https://doi.org/10.23876/j.krcp.21.189
  • Krismi A, Danarti R, Setiabudi IIDPP, Wirohadidjojo YW. Chronic kidney disease‐associated pruritus in patients undergoing hemodialysis: Xerosis and topical therapy. Hemodialysis International. 2023;27(2):91–104. https://doi.org/10.1111/hdi.13071
  • Chu SWF, Ng WJ, Yeam CT, Khan RQ, Low LL, Quah JHM, et al. Manipulative and body-based methods in chronic kidney disease patients: A systematic review of randomized controlled trials. Complement Ther Clin Pract. 2022;48(2022):101593. https://doi.org/10.1016/j.ctcp.2022.101593
  • Świerczyńska K, Białynicki-Birula R, Szepietowski JC. Chronic intractable pruritus in chronic kidney disease patients: prevalence, impact, and management challenges—a narrative review. Ther Clin Risk Manag. 2021;17:1267–82. https://doi.org/10.2147/TCRM.S310550
  • Lu PH, Chuo HE, Chiu LY, Lai CC, Wang JY, Lu PH. Comparative efficacy of acupuncture point stimulation treatments for dialysis patients with uremic pruritus: a systematic review and network meta-analysis. Front Neurol. 2024;15:1342788. https://doi.org/10.3389/fneur.2024.1342788
  • Shabi I, Aboudar Z, Sidki M, Amal S, Hocar O, Aboudourib M, et al. Effectiveness of narrowband ultraviolet light in chronic kidney disease-associated pruritus. Cureus. 2024;16(1):e53340. https://doi.org/10.7759/cureus.53340
  • Lin J, Chen C, Huang C, Lai F, Wang C. Effects of an ice roller on chronic kidney disease‐associated pruritus in patients receiving haemodialysis. J Ren Care. 2024:1–12. https://doi.org/10.1111/jorc.12491
  • Alqahtani S, Bakhamees BH, Almalki FM, Alshaer AB, Altaymani AF, Alazmi MM, et al. Efficacy and safety of omega-3 fatty acids in ameliorating pruritus in adult patients with chronic kidney disease: a meta-analysis of randomized controlled trials. Cureus. 2024;16(8):e66452. https://doi.org/10.7759/cureus.66452
  • Verma V, Lamture Y, Ankar R. Management of uremic xerosis and chronic kidney disease (ckd)-associated pruritus (ckd-ap) with topical preparations: a systematic review and ımplications in the ındian context. Cureus. 2023;15(7):e42587. https://doi.org/10.7759/CUREUS.42587
  • Shah P. Essential oils: How safe? How effective?. J Fam Pract. 2023;72(9):374–81. https://doi.org/10.12788/jfp.0672
  • naha.org [Internet]. National Association for Holistic Aromatherapy. Exploring Aromatherapy | NAHA. 2024[cited 2024 Oct 11]. Available from: https://naha.org/explore-aromatherapy/about-aromatherapy/what-is-aromatherapy/
  • Hedigan F, Sheridan H, Sasse A. Benefit of inhalation aromatherapy as a complementary treatment for stress and anxiety in a clinical setting - a systematic review. Complement Ther Clin Pract. 2023;52:101750. https://doi.org/10.1016/j.ctcp.2023.101750
  • Shaki Z, Ghaffari F, Alijaniha F, Kamalinejad M, Kazemnejad A, Daneshfard B, et al. Effect of dill (anethum graveolens) oil on pruritus and quality of life of hemodialysis patients: a randomized double-blind three-arm controlled trial. Evid Based Complement Alternat Med. 2024;2024(1):3077603. https://doi.org/10.1155/2024/3077603
  • Ghazanfari SM, Mirmoosavi SJ, Jamali J, Motavasselian M, Salari R. Inflammatory bio-marker changes in hemodialysis patients with pruritus receiving violet oil: A randomized controlled trial. J Herb Med. 2022;32:100538. https://doi.org/10.1016/j.hermed.2022.100538
  • Abbasi M, Shahrbabaki PM, Jahani Y, Mehdipour-Rabori R. The effect of topical chia oil and coconut oil on pruritus and laboratory parameters in hemodialysis patients. Evidence Based Care. 2022;12(3):56–63. https://doi.org/10.22038/ ebcj.2022.63945.2658
  • Sembiring F, Nasution SS, Ariani Y. The effects of topical peppermint aromatherapy on reducing uremic pruritus in chronic kidney disease patients undergoing hemodialysis. JKS [Internet]. 2021[cited 2024 Oct 11];16(1):31-6. Available from: http://jks.fikes.unsoed.ac.id/index.php/jks/article/view/1273
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Kronik Böbrek Hastalığı ile İlişkili Kaşıntı ve Aromaterapi/ Pruritus and Aromatherapy Associated with Chronic Kidney Disease

Year 2025, Volume: 20 Issue: 2, 139 - 146, 31.05.2025
https://doi.org/10.47565/ndthdt.2025.106

Abstract

Dünya genelinde yaygın bir hastalık olan kronik böbrek hastalığı böbrek fonksiyonlarının kalıcı olarak bozulmasıyla karakterizedir. Bu hastalıkta sıklıkla görülen dermatolojik problemler arasında yer alan kaşıntı ve cilt kuruluğu, hastaların yaşam kalitesini ciddi şekilde düşürmekte ve tedavi sürecini karmaşık hale getirmektedir. Kaşıntının patofizyolojisi; periferik nöropati, immün sistem dengesizlikleri, opioid reseptör dengesizlikleri, ciltte üremik toksin birikimine bağlı histaminerjik olmayan kaşıntı yolunun aktivasyonu, mikroinflamasyon ve kseroz gibi faktörlere dayanmaktadır. Kaşıntının yönetiminde farmakolojik tedavilere ek olarak non- farmakolojik yöntemler, özellikle aromaterapi, giderek artan bir şekilde kullanılmaktadır. Aromaterapide lavanta, menekşe, chia tohumu yağı ve daha birçok esansiyel yağ; topikal uygulama, masaj veya inhalasyon yoluyla uygulanarak kaşıntı ve kseroz semptomlarını hafifletmek amacıyla kullanılmaktadır. Mevcut literatür, aromaterapinin cilt semptomlarını ve kaşıntıyı azaltmada potansiyel olarak etkili olabileceğini göstermektedir. Ancak, bu tedavi yönteminin etkinliğini ve güvenilirliğini belirlemek için uygulama protokollerinin standardizasyonu ve esansiyel yağların etkililiğini inceleyen daha kapsamlı araştırmalara ihtiyaç duyulmaktadır. Aromaterapinin etkilerinin daha geniş örneklem grupları ile karşılaştırmalı klinik çalışmalarla değerlendirilmesi, bu alandaki kanıt seviyesini artırmak açısından büyük önem taşımaktadır.

References

  • theisn.org. [Internet] International Society of Nephrology. ISN–Global Kidney Health Atlas. 2023(Internet). 2023[cited 2024 Oct 11]. Available from: www.theisn.org/global-atlas
  • hsgm.saglik.gov.tr [Internet]. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Türkiye Böbrek Hastalıkları Önleme ve Kontrol Programı. 2018[cited 2024 Oct 11]. Available from: https://hsgm.saglik.gov.tr/depo/birimler/kronik-hastaliklar-ve-yasli-sagligi db/Dokumanlar/Kitaplar/Turkiye_Bobrek_Hastaliklari_Onleme_ve_Kontrol_Programi_2018-2023.pdf
  • Varol E, Sivrikaya SK. Kronik böbrek yetmezliğinde yaşam kalitesi ve hemşirelik. J DU Health Sci Inst (Internet). 2018[cited 2024 Oct 11];8(2):89–96. Available from: https://dergipark.org.tr/tr/download/article-file/504947
  • Tayaz E, Koç A. Hemodiyaliz tedavisi alan kronik böbrek yetmezliği hastalarında semptom yönetimi ve hemşirelik. JANHS [Internet]. 2020[cited 2024 Oct 11];23(1):147–56. Available from: https://dergipark.org.tr/tr/download/article-file/1013655
  • Rashpa R, Mahajan V, Kumar P, Mehta K, Chauhan P, Rawat R, et al. Mucocutaneous manifestations in patients with chronic kidney disease: A cross-sectional study. Indian Dermatol Online J. 2018;9(1):20-6. https://doi.org/10.4103/idoj.IDOJ_160_17
  • Tajalli F, Mirahmadi SMS, Mozafarpoor S, Goodarzi A, Nasiri Partovi M, Lakestani D. Mucocutaneous manifestations of patients with chronic kidney disease under hemodialysis: A cross-sectional study of 49 patients. Dermatol Ther. 2021;34(4):e15015. https://doi.org/10.1111/DTH.15015
  • Engler F, Kerschbaum J, Keller F, Mayer G, Antlanger M, Edlinger R, et al. Prevalence, patient burden and physicians’ perception of pruritus in haemodialysis patients. Nephrol Dial Transplant. 2024;39(2):277–85. https://doi.org/10.1093/ ndt/gfad152
  • Wulczyn KE, Steele DJR. One-year pruritus trends among patients receiving hemodialysis and associated outcomes. Am J Kidney Dis. 2023;82(6):647–9. https://doi.org/10.1053/j.ajkd.2023.08.004
  • Sukul N, Karaboyas A, Csomor PA, Schaufler T, Wen W, Menzaghi F, et al. Self-reported pruritus and clinical, dialysis-related, and patient-reported outcomes in hemodialysis patients. Kidney Med. 2021;3(1):42-53. https://doi.org/10.1016/ j.xkme.2020.08.011
  • Orasan OH, Muresan F, Mot A, Sitar Taut A, Minciuna I, Coste SC, et al. Hemodialysis patients with pruritus and ınsomnia have ıncreased risk of death. Blood Purif. 2020;49(4):419–25. https://doi.org/10.1159/000505147
  • Schricker S, Kimmel M. Unravelling the pathophysiology of chronic kidney disease-associated pruritus. Clin Kidney J. 2021;14(3):23–31. https://doi.org/10.1093/ckj/sfab200
  • Lipman ZM, Paramasivam V, Yosipovitch G, Germain MJ. Clinical management of chronic kidney disease-associated pruritus: current treatment options and future approaches. Clin Kidney J. 2021;14(3):16–22. https://doi.org/10.1093/ckj/sfab167
  • Hu X, Sang Y, Yang M, Chen X, Tang W. Prevalence of chronic kidney disease-associated pruritus among adult dialysis patients. Medicine. 2018;97(21):e10633. https://doi.org/10.1097/MD.0000000000010633
  • Kazak A, Özkaraman A. Üremik pruritus ve hemşirelik yönetimi. CBU-SBED. 2020;7(3):408–12. https://doi.org/10.34087/CBUSBED.695705
  • Manenti L, Leuci E. Do you feel itchy? A guide towards diagnosis and measurement of chronic kidney disease-associated pruritus in dialysis patients. Clin Kidney J. 2021;14(3):8–15. https://doi.org/10.1093/ckj/sfab143
  • Şahin A, Sarıtaş SÇ, Soylu A. Üremik kaşıntıda kullanılan tamamlayıcı sağlık yaklaşımları. NefroHemDergi. 2020;15(2):96–103. https://doi.org/10.47565/NDTHDT.2020.11
  • Kavurmacı M, Tan M. Üremik kaşıntı ve hemşirelik bakımı. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2015;18(1):57–62. https://doi.org/10.17049/AHSBD.82817
  • Cheng AY, Wong LS. Uremic pruritus: from diagnosis to treatment. Diagnostics (Basel). 2022;12(5):1108. https://doi.org/10.3390/DIAGNOSTICS12051108
  • Topf J, Wooldridge T, McCafferty K, Schömig M, Csiky B, Zwiech R, et al. Efficacy of difelikefalin for the treatment of moderate to severe pruritus in hemodialysis patients: pooled analysis of KALM-1 and KALM-2 phase 3 studies. Kidney Med. 2022;4(8):100512. https://doi.org/10.1016/j.xkme.2022.100512
  • Ko MJ, Peng YS, Wu HY. Uremic pruritus: Pathophysiology, clinical presentation, and treatments. Kidney Res Clin Pract. 2023;42(1):39–52. https://doi.org/10.23876/j.krcp.21.189
  • Krismi A, Danarti R, Setiabudi IIDPP, Wirohadidjojo YW. Chronic kidney disease‐associated pruritus in patients undergoing hemodialysis: Xerosis and topical therapy. Hemodialysis International. 2023;27(2):91–104. https://doi.org/10.1111/hdi.13071
  • Chu SWF, Ng WJ, Yeam CT, Khan RQ, Low LL, Quah JHM, et al. Manipulative and body-based methods in chronic kidney disease patients: A systematic review of randomized controlled trials. Complement Ther Clin Pract. 2022;48(2022):101593. https://doi.org/10.1016/j.ctcp.2022.101593
  • Świerczyńska K, Białynicki-Birula R, Szepietowski JC. Chronic intractable pruritus in chronic kidney disease patients: prevalence, impact, and management challenges—a narrative review. Ther Clin Risk Manag. 2021;17:1267–82. https://doi.org/10.2147/TCRM.S310550
  • Lu PH, Chuo HE, Chiu LY, Lai CC, Wang JY, Lu PH. Comparative efficacy of acupuncture point stimulation treatments for dialysis patients with uremic pruritus: a systematic review and network meta-analysis. Front Neurol. 2024;15:1342788. https://doi.org/10.3389/fneur.2024.1342788
  • Shabi I, Aboudar Z, Sidki M, Amal S, Hocar O, Aboudourib M, et al. Effectiveness of narrowband ultraviolet light in chronic kidney disease-associated pruritus. Cureus. 2024;16(1):e53340. https://doi.org/10.7759/cureus.53340
  • Lin J, Chen C, Huang C, Lai F, Wang C. Effects of an ice roller on chronic kidney disease‐associated pruritus in patients receiving haemodialysis. J Ren Care. 2024:1–12. https://doi.org/10.1111/jorc.12491
  • Alqahtani S, Bakhamees BH, Almalki FM, Alshaer AB, Altaymani AF, Alazmi MM, et al. Efficacy and safety of omega-3 fatty acids in ameliorating pruritus in adult patients with chronic kidney disease: a meta-analysis of randomized controlled trials. Cureus. 2024;16(8):e66452. https://doi.org/10.7759/cureus.66452
  • Verma V, Lamture Y, Ankar R. Management of uremic xerosis and chronic kidney disease (ckd)-associated pruritus (ckd-ap) with topical preparations: a systematic review and ımplications in the ındian context. Cureus. 2023;15(7):e42587. https://doi.org/10.7759/CUREUS.42587
  • Shah P. Essential oils: How safe? How effective?. J Fam Pract. 2023;72(9):374–81. https://doi.org/10.12788/jfp.0672
  • naha.org [Internet]. National Association for Holistic Aromatherapy. Exploring Aromatherapy | NAHA. 2024[cited 2024 Oct 11]. Available from: https://naha.org/explore-aromatherapy/about-aromatherapy/what-is-aromatherapy/
  • Hedigan F, Sheridan H, Sasse A. Benefit of inhalation aromatherapy as a complementary treatment for stress and anxiety in a clinical setting - a systematic review. Complement Ther Clin Pract. 2023;52:101750. https://doi.org/10.1016/j.ctcp.2023.101750
  • Shaki Z, Ghaffari F, Alijaniha F, Kamalinejad M, Kazemnejad A, Daneshfard B, et al. Effect of dill (anethum graveolens) oil on pruritus and quality of life of hemodialysis patients: a randomized double-blind three-arm controlled trial. Evid Based Complement Alternat Med. 2024;2024(1):3077603. https://doi.org/10.1155/2024/3077603
  • Ghazanfari SM, Mirmoosavi SJ, Jamali J, Motavasselian M, Salari R. Inflammatory bio-marker changes in hemodialysis patients with pruritus receiving violet oil: A randomized controlled trial. J Herb Med. 2022;32:100538. https://doi.org/10.1016/j.hermed.2022.100538
  • Abbasi M, Shahrbabaki PM, Jahani Y, Mehdipour-Rabori R. The effect of topical chia oil and coconut oil on pruritus and laboratory parameters in hemodialysis patients. Evidence Based Care. 2022;12(3):56–63. https://doi.org/10.22038/ ebcj.2022.63945.2658
  • Sembiring F, Nasution SS, Ariani Y. The effects of topical peppermint aromatherapy on reducing uremic pruritus in chronic kidney disease patients undergoing hemodialysis. JKS [Internet]. 2021[cited 2024 Oct 11];16(1):31-6. Available from: http://jks.fikes.unsoed.ac.id/index.php/jks/article/view/1273
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There are 48 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases Nursing​
Journal Section Article
Authors

Semanur Bilgiç 0000-0001-9839-0307

Aysun Acun 0000-0003-0049-2669

Burcu Bayrak Kahraman 0000-0003-2301-1274

Publication Date May 31, 2025
Submission Date October 11, 2024
Acceptance Date January 9, 2025
Published in Issue Year 2025 Volume: 20 Issue: 2

Cite

Vancouver Bilgiç S, Acun A, Bayrak Kahraman B. Kronik Böbrek Hastalığı ile İlişkili Kaşıntı ve Aromaterapi/ Pruritus and Aromatherapy Associated with Chronic Kidney Disease. JoNN. 2025;20(2):139-46.

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