Refers to the signs and symptoms of advanced kidney failure.

Largely due to the accumulation of organic waste products cleared from the kidneys.

No specific point in time delineates the onset of uremia.

Develops when patients have stage 4-5 chronic kidney disease.

Features may be present with glomerular filtration rate barely below 50% of the normal rate.

Some degree of uremic symptoms present in an estimated 8 million people with GFR below 60 ml per minute per 1.73 m2 of body surface area.

Secondary organ involvement of the gastrointestinal system such as uremic gastroenteritis, peripheral neuropathy, and pericarditis.

Uremic pruritus is associated with depression and other adverse outcomes.
Patients undergoing dialysis have less severe and frequent symptoms than those who receive inadequate dialysis.
Uremic pruritus generally resolves in patients with end-stage renal disease who undergo renal transplantation.

Early symptoms are nonspecific, like fatigue.

Treatment predominantly by dialysis.

5 year survival for hemodialysis and peritoneal dialysis from 1995-1999 was under 35%.

Patients on dialysis frequently have “residual syndrome” (Depner) with partially treated uremia manifested by illness from extracellular fluid volume fluctuations, exposure to bioincompatible materials , inorganic ion abnormalities, acidosis, hyperphosphatemia with complications of systemic diseases and advanced age responsible for the loss of renal function.

Dialysis initiated when the symptoms, particularly anorexia and lethargy, are prominent and at the time when treatment is expected to relieve such symptoms.

Initiation of dialysis usually when the GFR is about 7% of normal, and conventional dialysis only slightly provides better removal of many solutes but is inferior in its removal of some.

Renal replacement treatment does not completely relieve uremic symptoms.

Renal transplantation reverses the residual syndrome indicates the presence of toxic solutes continue to accumulate during dialysis.

Successful renal transplantation which can restore the glomerular filtration rate to more than half of its normal value improves all aspects of the quality of life of such patients.

Difelikefaln is efficacious for the treatment of uremic pruritus.

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