{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T21:04:40Z","timestamp":1773781480266,"version":"3.50.1"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T00:00:00Z","timestamp":1740441600000},"content-version":"vor","delay-in-days":55,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Nephrology"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>\n                    <jats:bold>Introduction:<\/jats:bold>\n                    Chronic kidney disease\u2013associated pruritus (CKD\u2010aP) is a frequently experienced, unpleasant skin condition. Difelikefalin, an agonist of the kappa opioid receptor, is indicated for the treatment of moderate\u2010to\u2010severe CKD\u2010aP in adult patients on hemodialysis. Reports of the effectiveness of difelikefalin in complex patient cases encountered in routine clinical practice are rare.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Case Presentation:<\/jats:bold>\n                    The presented patient had a complex interplay of morbidities, most notably diabetes mellitus type 2, tertiary hyperparathyroidism, end\u2010stage renal disease (ESRD), and CKD\u2010associated mineral bone disease (CKD\u2010MBD), all of which are associated with the development and severity of CKD\u2010aP. The patient\u2019s CKD\u2010aP was resistant to H\n                    <jats:sub>1<\/jats:sub>\n                    \u2010receptor antagonists and gabapentin and showed no improvement after parathyroidectomy. Treatment with difelikefalin rapidly and sustainably improved symptoms, with a brief recurrence of itching toward the end of each long interdialytic interval. Apart from a short episode of vertigo at the initiation of treatment, no adverse events were observed over the long duration of treatment (currently more than 2.5\u2009years).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    In a patient with longstanding conditions and multiple comorbidities, difelikefalin showed sustained effectiveness against H\n                    <jats:sub>1<\/jats:sub>\n                    \u2010receptor antagonist\u2013 and gabapentin\u2013resistant CKD\u2010aP. Difelikefalin was well tolerated over the long term.\n                  <\/jats:p>","DOI":"10.1155\/crin\/6626611","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:57:16Z","timestamp":1740531436000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Successful Use of Difelikefalin in Severe Chronic Kidney Disease\u2013Associated Pruritus in a Patient With Complex Etiological Contributors: A Case Report"],"prefix":"10.1155","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2507-1377","authenticated-orcid":false,"given":"Johannes M.","family":"Werzowa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1877-6838","authenticated-orcid":false,"given":"Margit","family":"Hemetsberger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,25]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2020.08.011"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2023.04.008"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfad152"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.2215\/cjn.09480822"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5000251"},{"key":"e_1_2_12_6_2","unstructured":"World Health Organization ICD-11 for Mortality and Morbidity Statistics (Version: 01\/2023): EC90 Pruritus 2023 2025 https:\/\/icd.who.int\/browse\/2025-01\/mms\/en."},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.2147\/ijnrd.s108045"},{"key":"e_1_2_12_8_2","doi-asserted-by":"publisher","DOI":"10.2215\/cjn.00100110"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2013.454"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfac187"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2005020157"},{"key":"e_1_2_12_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2020.04.027"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.14953"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.3109\/09546634.2016.1161161"},{"key":"e_1_2_12_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-014-0795-x"},{"key":"e_1_2_12_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/toxins13080527"},{"key":"e_1_2_12_17_2","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2018010096"},{"key":"e_1_2_12_18_2","doi-asserted-by":"publisher","DOI":"10.1159\/000518391"},{"key":"e_1_2_12_19_2","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00827.2013"},{"key":"e_1_2_12_20_2","volume-title":"Kapruvia-Summary of Product Characteristics","author":"European Medicines Agency","year":"2022"},{"key":"e_1_2_12_21_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1912770"},{"key":"e_1_2_12_22_2","doi-asserted-by":"publisher","DOI":"10.1681\/asn.20203110s122d"},{"key":"e_1_2_12_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2022.100512"},{"key":"e_1_2_12_24_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-1763"},{"key":"e_1_2_12_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfl461"},{"key":"e_1_2_12_26_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0245370"},{"key":"e_1_2_12_27_2","doi-asserted-by":"publisher","DOI":"10.2147\/ijnrd.s52985"},{"key":"e_1_2_12_28_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-015-0177-3"},{"key":"e_1_2_12_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-023-03438-6"},{"key":"e_1_2_12_30_2","first-page":"203","article-title":"The Disappearance of Intractable Pruritus After Parathyroidectomy in Uremic Patients With Secondary Hyperparathyroidism","volume":"81","author":"Kleeman C. 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