Identifying the high-risk dialysis patient: what are the benefits?

during erythropoietin therapy [6]. These results have not been confirmed by another controlled study [7]. Favourable effects with electrical needle stimulation, ketotifen, which is a mast-cell stabilizer, and topical capsaicin, which would deplete the pruritogenic substance P in peripheral sensory neurons have been reported. These trials have been conducted on very small numbers of patients and need to be confirmed by further studies. Waiting for more intensive investigations on this orphan symptom we suggest the following approach. First the pruritic patient should be evaluated by a dermatologist to rule out any cause of itching other than uraemia. Then the adequacy of dialysis should be carefully checked. It is a common experience that pruritus is more frequent in underdialysed patients and may improve by increasing the efficacy of dialysis. The calcium—phosphorus product should be kept as low as a possible to avoid microprecipitations that can irritate the skin. Adequate measures should be taken to treat severe hyperparathyroidism. In well-dialysed patients without specific skin disease or severe hyperparathyroidism, we suggest starting with UVB phototherapy. Nicergoline (30 mg q. day per os) may be offered to the few non-responders. Electrical needle stimulation, ketotifen (l-2mg b.day) or topical capsaicin can be Nephrol Dial Transplant 1995: Editorial Comments