Skin Deep

By Lubna Akbany, RD, CSR,

Help! I can’t stop this itching! This is a cry that many of us living with kidney disease are familiar with. Having kidney disease myself, I was not sheltered from this either. Itchy skin can make you miserable, and it’s a common problem for many people with chronic kidney disease (CKD), even for those not on dialysis.

Many of us have experienced some form of it. Some feel itchy all the time over their entire body, while for others it comes and goes and may happen only in certain areas. Some also say itching is worse during, or just after, dialysis treatment. What’s important is trying to understand the cause and then finding the best way to manage it.

Types of itchy skin:


Itching (pruritus) A common cause of itching is a high level of phosphorus in the body. Because dialysis does not effectively remove phosphorus, a renal diet that limits foods high in phosphorous can relieve pruritus by maintaining a phosphorus level at 5.5 mg/dl or less. Additionally, taking phosphorus binders with every meal and with snacks can help. Staying on dialysis for the full treatment time is also recommended because it can remove some phosphorus as well as other wastes and toxins. If phosphorus levels continue to remain elevated, calciphylaxis can develop.

Calciphylaxis Calciphylaxis (kal-sih-fuh-LAK-sis) is a serious, but uncommon, disease in those on dialysis. People with calciphylaxis have an imbalance in the metabolism of calcium, whereby calcium accumulates in small blood vessels of the fat and skin tissues. This causes blood clots, painful skin ulcers, and may cause serious infections that can lead to death.


Dry skin (xerosis) Kidney failure may create changes in the sweat glands and oil glands which cause the skin to dry out. Dry skin can lead to infections and excess itching. Skin wounds may heal more slowly when the skin is dry.



Skin discoloration (hyperpigmentation) Many reported cases of discolored skin, or hyperpigmentation, happen to people with CKD. 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-colored skin. Another discoloration is called uremic frost. This is a white, powdery substance left on the skin surface after sweat dries. When a patient’s blood urea nitrogen (BUN) level is high, the concentration of urea in sweat increases greatly. Evaporation of this kind of sweat causes urea to crystallize and deposit on the skin. Uremic frost is prevented by getting adequate dialysis.

What causes dry, itchy skin? A combination of things can cause your skin to be itchy and dry.

• Limited fluid intake: Your dialysis treatment removes extra water from your body, and your limited fluid intake between treatments can cause dry skin and trigger itchiness.

• Unmanaged phosphorous: Often, itching is caused by high blood levels of phosphorus. In your body, extra phosphorus can bind with calcium and lead to feeling itchy. If your healthcare provider has given you phosphate binders, it will help to take them at the same time every day and as instructed. Try to maintain your phosphorus levels at 5.5 mg/dl or less.

• Not enough dialysis: Talk to your healthcare team about your symptoms and find out if you are getting the right amount of dialysis. Sometimes too much or too little dialysis can lead to symptoms such as dry, itchy skin.

• Allergies and other causes: Be sure you are not sensitive to the soaps, laundry detergents, lotions, or perfumes you may be using. Sometimes the dyes and fragrances in these products can cause allergic reactions that make skin itchy. Also, taking baths with water that is too hot can leave your skin too dry and lead to itchy skin.

Useful Tips:

Try to figure out what is causing the itching. Is it better at some times than others? What helps it or makes it worse? Tell your healthcare team what changes you feel and see with your skin.

• Develop a good skincare routine, with daily cleansing and moisturizing. Ask your healthcare team which moisturizers work best for your symptoms.

• Don’t scratch your skin! Scratching tends to make the itching worse, and may even damage the skin and lead to infection.

• Stick to the diet given to you by your healthcare team.

• Make sure you are taking your phosphate binders as prescribed.

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Lubna Akbany, RD, CSR, is a Registered Dietitian Nutritionist and Certified Specialist in Renal Nutrition with over 20 years’ experience. She specializes in chronic kidney disease (CKD) management and diabetes with a focus on CKD nutrition. She is a mom, a patient, and an effective nutrition communicator who loves cooking and eating delicious food with friends and family.