Phototherapy as a potential treatment for chronic kidney disease-associated pruritus: exploring the relationship between the skin, sleep and inflammation.

PURPOSE: The skin is an organ that can reflect internal issues. For example, the chronic kidney disease-associated pruritus (CKD-aP) is a result of uremia, and is known to impair the quality of life and sleep of those affected. In this communication, we aimed to raise the potential benefits of phototherapy for individuals with CKD-aP, including an adjuvant effect on the sleep quality.

METHODS

A brief review of the literature using the MEDLINE/PubMed database was conducted to synthesize concepts from identified studies supporting the link between CKD-aP and sleep disturbance, including the role of inflammatory cytokines and phototherapy.

RESULTS

Immune and inflammatory aspects can be imbalanced by kidney disease, which in turn can have further repercussions in respect of poor sleep. Some pro-inflammatory cytokines have already been shown to be somnogenic, as well as being related with uremic pruritus severity and its triggering, through complex interconnected pathways. Ultraviolet B phototherapy is highlighted as a therapeutic tool that can improve uremic pruritus and have an effect on sleep, although further research is needed in respect of its effects on inflammatory cytokines and circadian rhythm.

CONCLUSIONS

A better understanding of this triple interaction between sleep, pruritus and phototherapy may help to improve the management of uremic pruritus and the quality of life of nephropathic individuals. Based on the current literature, we highlight the potential of skin phototherapy to improve CKD-aP and sleep quality through the regulation of melatonin and cytokines.