SynthesisRenal failure2026
Real-world effectiveness and safety of difelikefalin for chronic kidney disease-associated pruritus: a systematic review.
Synthesis in Renal failure, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
5 authors.
Funding
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Abstract
introductionChronic kidney disease-associated pruritus (CKD-aP) affects 55% of hemodialysis patients and substantially impairs quality of life (QoL) and treatment adherence. Difelikefalin, a selective kappa-opioid receptor agonist, received regulatory approval following the KALM trials. However, the applicability of these findings to routine practice remains unclear. We systematically evaluated real-world evidence (RWE) on the effectiveness and safety of difelikefalin in patients with CKD-aP.
methodsComprehensive searches of PubMed, Embase, CENTRAL, Scopus, Web of Science, and CINAHL were conducted on 15 December 2025. Inclusion criteria were RWE studies, including observational studies and trial extension analyses reporting the efficacy (WI-NRS and 5-D Itch scores), QoL (Skindex-10), or safety in patients with CKD-aP using difelikefalin. Exclusion criteria included RCTs without open-label extensions and pruritus due to alternative causes. Two reviewers independently screened studies and extracted data. The study was prospectively registered as CRD420251266218.
resultsTwelve studies (
conclusionsRWE supports the effectiveness of difelikefalin in hemodialysis patients with CKD-aP. However, included studies are heterogeneous and at high risk of bias. Future research should investigate difelikefalin in peritoneal dialysis and earlier-stage CKD cohorts, alongside health economic evaluations and implementation studies.
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