{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:49:58Z","timestamp":1791614998436,"version":"4.3.4"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Chronic kidney disease-associated pruritus (CKD-aP) remains a prevalent and burdensome symptom whose management is often empirical and only partially effective. Its pathophysiology appears to arise from interacting systemic, cutaneous, neural, and central mechanisms rather than from a single dominant pathway. In this review, we synthesize the evidence for a broader neuroimmune framework encompassing retained uremic solutes, microinflammation, xerosis and barrier dysfunction, immune dysregulation, neuropathic sensitization, opioid imbalance, and neuropeptide signaling. On this basis, we propose a four-node organizing model\u2014Peripheral Neuroimmune Synapse (Node I), Neural Transmission and Hyperexcitability (Node II), Central Opioid Modulation (Node III), and Substance P\/NK-1 Amplification (Node IV)\u2014to translate mechanistic complexity into clinically intelligible domains. This model is intended as a pragmatic and hypothesis-generating framework, not as a validated endotyping system. Framed this way, it may help contextualize the observed benefits of therapies such as gabapentinoids and difelikefalin, clarify the limited performance of traditional antihistamine-based strategies, and support a more structured approach to bedside phenotyping and future enrichment-based trials. Prospective validation remains necessary before mechanism-guided therapeutic matching can be recommended as routine clinical practice.<\/jats:p>","DOI":"10.1093\/joneph\/aajag135","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T11:24:37Z","timestamp":1778585077000},"page":"1101-1107","source":"Crossref","is-referenced-by-count":0,"title":["The neuroimmune architecture of uremic pruritus: mechanisms and therapeutic targeting"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7247-4950","authenticated-orcid":false,"given":"Lucas Maciel de Almeida","family":"Corr\u00eaa","sequence":"first","affiliation":[{"name":"Department of Nephrology, Faculdade de Medicina de S\u00e3o Jos\u00e9 do Rio Preto (FAMERP) , S\u00e3o Jos\u00e9 do Rio Preto, S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Let\u00edcia Esteves","family":"Dante","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculdade de Medicina de S\u00e3o Jos\u00e9 do Rio Preto (FAMERP) , S\u00e3o Jos\u00e9 do Rio Preto, S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura de Azevedo","family":"Catenaccio","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculdade de Medicina de S\u00e3o Jos\u00e9 do Rio Preto (FAMERP) , S\u00e3o Jos\u00e9 do Rio Preto, S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thifanny Rodrigues","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculdade de Medicina de S\u00e3o Jos\u00e9 do Rio Preto (FAMERP) , S\u00e3o Jos\u00e9 do Rio Preto, S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz Cossini Bonavita","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculdade de Medicina de S\u00e3o Jos\u00e9 do Rio Preto (FAMERP) , S\u00e3o Jos\u00e9 do Rio Preto, S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiggi Kevin Virgino","family":"Brand\u00e3o","sequence":"additional","affiliation":[{"name":"Centro Universit\u00e1rio UNINORTE (UNINORTE) , Rio Branco, Acre ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre de Assis","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Universidade Estadual de Mato Grosso do Sul (UEMS) , Campo Grande, Mato Grosso do Sul ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Costa","family":"de Santana","sequence":"additional","affiliation":[{"name":"Universidade Salvador (UNIFACS) , Salvador, Bahia 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