The Pathogenesis of CKD - Associated Pruritus (CKD-aP): A Theoretical Model and Relevance for Treatment.

Our understanding of the pathogenesis of uremic pruritus (also known as Chronic Kidney Disease - associated pruritus (CKD-aP)) remains elusive. While multiple discrete changes in the immuno-chemical milieu of the skin of patients with CKD-aP have been described, a coherent theory of mechanism is absent. This article proposes a theoretical model of mechanism. It concentrates on the initiation phase of CKD-aP and its three parts: 1) Genesis, triggered by first precipitants; 2) Cascade of cytokine release that follows and the cross-talking of multiple skin cells with each other and afferent nerve fibers and 3) Enhancement. The limitation of the model will be described and ideas for future research proposed. Implications for management shall be examined.