Exploring novel skin biomarkers related to pruritus in dialysis patients

PURPOSE: Pruritus is a common and distressing symptom among dialysis patients, yet its underlying mechanisms remain incompletely understood. Most previous research has focused on systemic inflammatory markers, while little is known about local skin alterations contributing to pruritus. This study aimed to characterize skin biomarker profiles in dialysis patients with pruritus, in comparison with dialysis patients without pruritus and healthy controls, and to explore differences between pruritic and non-pruritic skin sites. METHODS: In this multi-center cross-sectional exploratory study, stratum corneum samples were obtained using the tape-stripping method from 91 participants (67 dialysis patients and 24 healthy controls). Biomarkers were quantified, and adjusted linear and logistic (mixed) models were used to assess group differences and skin site variations. RESULTS: Dialysis patients with pruritus exhibited a significantly elevated IL-1RA/IL-1α ratio and reduced IL-18 levels compared to non-pruritic patients. There was also a strong indication of concomitant increases in IL-1RA and IFN-β in pruritic skin. Across all dialysis patients, IL-8, CCL17, and CXCL10 levels were significantly lower than in healthy controls, independent of pruritus status. CONCLUSION: Dialysis patients with pruritus demonstrate distinct alterations in skin immune profiles suggestive of localized inflammation and potential involvement of the opioid pathway. These findings provide new insights into the inflammatory mechanisms underlying pruritus in this population and may inform the development of targeted, personalized therapies.