Chronic Kidney disease can trigger different skin conditions. Skin manifestations among CKD patients and people on dialysis are common. Additionally, it is also common to experience skin changes associated with the origin of kidney disease, such as diabetes.

Skin problems with CKD

Dermatological manifestations related to CKD can affect the quality of your life. Besides the physical aspect, it can also impact your mental health. Learning about these skin conditions can help you address them appropriately. Moreover, it can also help in establishing an accurate diagnosis. 

Severe CKD-associated pruritus, previously called uremic pruritus is linked to increased mortality and a poor prognosis. Meanwhile, comorbidities such as diabetes can result in acquired perforating dermatosis (refers to any skin disease) and calciphylaxis.

In calciphylaxis, the calcium accumulates in small blood vessels of the fat and skin tissues. This severe, uncommon disease causes blood clots and skin ulcers. It may trigger serious infections that can result in death.

Can kidney disease cause skin problems?

Kidneys filter waste from the bloodstream. However, wastes accumulate in the blood when the kidneys fail to perform their role. Poor kidney function can lead to kidney disease.

Many people with CKD will not have symptoms at the early stages because the body can usually cope with the decline in kidney function. At this stage, kidney disease is often only diagnosed through a routine test for another health concern.

Nonspecific Skin Changes

As your CKD progresses, you may develop different skin issues. Furthermore, skin problems can occur if your CKD is caused by an underlying condition such as diabetes. Over half of all end-stage renal disease (ESRD) patients have nonspecific skin conditions such as skin discoloration, itching (pruritus), and dry skin (xerosis).

1. Skin discoloration and pigmentation

Toxins build up in the body when kidney function declines. This toxin accumulation can result in skin discoloration and pigmentation. You may manifest unhealthy pale color, gray hue, yellowish color, or darkened skin. Cyst and spots that appear like whiteheads, bumps, and deep lines can also develop.

Pale skin color is likely associated with anemia, whereas the gray hue is usually due to hemosiderin deposition. Anemia is a common complication of CKD, as the kidneys can’t filter the blood properly.

Hemosiderin is a protein compound that stores iron in skin tissues. This condition is called hemosiderin staining.  As a result, your skin can appear yellow, brown, or black staining or an appearance similar to a bruise. Hemosiderin staining mostly appears on the lower leg, between the knee and ankle. 

2. Itchy Skin (Pruritus)

CKD patients in advanced stages and dialysis patients may experience itchy skin at some point. The skin itch can be irritating to life-disrupting, as it can spread across most parts of the body. Some can feel the itchiness all the time while others’ experience comes and goes. A high level of phosphorus in the body can be a common cause of itching. Moreover, allergies can also cause itching. Patients who just started dialysis treatment may notice skin itchiness. When this happens, patients may be allergic to the blood tubing, dialyzer, and the type of heparin being used, or other elements related to the treatment.

Itchy skin treatment

Several factors can be contributed to pruritus such as allergies, dry skin, hot weather, eczema, diabetes, iron deficiency, and anemia. High levels of magnesium, phosphate, and aluminum can also cause itchy skin. You can relieve skin itchiness through the following:

• Taking oral antihistamines
• Wearing non-irritating clothing made of natural fabrics
• Avoiding dry environments
• Patting your skin dry after a bath or shower
• Using an unscented moisturizer on dry areas of skin
• Taking medicines such as gabapentin and/or pregabalin can also reduce itching by affecting the way nerves work. Seek expert medical advice as these are prescription medications.

If your skin itching worsens after dialysis, it is advised to always stick to your dialysis schedule as advised by your nephrologist. On the other hand, if you receive a kidney transplant, skin itchiness will eventually go away.

3. Dry skin (Xerosis)

50% to 85% of patients on dialysis have xerosis or dryness of the skin. Reduced secretion of sweat minimizes skin hydration, preventing the elimination of electrolytes, urea, proteins, and other minerals. Skin can become so dry that it becomes rough and scaly, cracks easily, and feels tight and cracks easily. Although dry skin can spread across the body, it is usually prominent on the forearms, legs, and thighs. Dry skin can result in infections, making skin wounds heal slower than they should.

Dry Skin Treatment

You can prevent or treat dry skin by avoiding long, hot showers or baths. Using unscented and soaps that don’t have harsh chemicals is also helpful. Pat skin dry instead of rubbing water off,  then apply moisturizer after a bath to lock in moisture on the skin. Make sure to use moisturizers that contain natural ingredients and are Paraben-free. You could also try using certified Virgin Coconut Oil or Virgin Olive Oil as your natural moisturizer, both have hydrating and anti-inflammatory properties.

4. Calciphylaxis (Calcium deposits in the skin)

Calciphylaxis is a rare but serious kidney complication that causes calcium build-up inside the blood vessels of the fat and skin. This condition can lead to the formation of very painful skin lesions and serious infections. When the kidneys cannot maintain a healthy balance of minerals in the blood, mineral levels can increase. The calcium deposits typically develop around a joint, but they can occur within a fingertip where it becomes painful.

Calciphylaxis Treatment

Calciphylaxis treatment is still experimental. However, you can prevent this conditioning from worsening through dietary changes. Your doctor could also change your dialysis prescription, medication, and frequency if you are on kidney dialysis. Your nephrologist can also evaluate your existing medications to eliminate possible triggers for calciphylaxis. Another medication your nephrologist can prescribe is sodium thiosulfate that can decrease calcium buildup in the arterioles. Check-in with your nephrologist for medications that can balance calcium and phosphorus in the body.

Other Skin Problems in CKD

Besides the dermatological conditions mentioned above, CKD patients can also experience swollen faces, thighs, legs, ankles, and feet due to sodium retention. Rash, blisters, and changes in the nail can also happen when the kidneys cannot remove waste from the body.

Addressing these other skin problems

The best way to address your CKD-related skin problem is to check in with your nephrologist. They may work with a dermatologist for skin conditions that are hard to control, diagnose or treat.

The Bottom line

Skin conditions brought by CKD can be exhausting and life-disrupting. Nevertheless, you must be aware of these skin issues to prevent, treat or avoid them from worsening. Talk to your nephrologist if you are experiencing any skin issues. They may adjust your medications or refer you to a dermatologist to assess your skin issues and treat them properly. Your dermatologist can identify skin manifestations that may not be related to your CKD and prescribe appropriate medications and remedies.