An option for patients experiencing major discomfort, despite the uncertainties. In two double-blind randomised trials including about 850 patients with chronic kidney disease and on haemo-dialysis, difelikefalin, a kappa opioid receptor agonist, was effective in reducing pruritus in the short-term in 15% to 20% more patients than in the placebo groups. Difelikefalin mainly carries a risk of gastrointestinal, neuropsychiatric, and perhaps sometimes serious cardiac disorders. In practice, despite the uncertainties, difelikefalin is an option to consider, with care, in patients who experience major discomfort despite non-pharmacological measures.
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