We read with interest the recent review entitled “Skin Manifestations of Chronic Kidney Disease,”1 and would like to add some comments based on our own experience and several articles we have published on this topic in Actas Dermo-Sifiliográficas. While we agree that uremic pruritis—the main symptom experienced by patients on hemodialysis for chronic kidney disease (CKD)—is difficult to control, we believe that the care of the xerosis that accompanies such pruritus can often be of great help and that the role of the dermatologist is central to that care.2,3 The effectiveness of erythropoietin cited by Robles-Méndez et al. on the basis of one study4 has been called into question by other authors5; moreover, erythropoietin is prescribed to almost all patients on hemodialysis, and no differences in the incidence or severity of pruritus have been observed between patients who are receiving such treatment and those who are not.2,6 We agree that the only definitive treatment for this condition is kidney transplantation.7 However, given the difficulty of achieving transplantation—the only curative treatment—for all patients with advanced CKD and uremic pruritus, we must keep looking for other treatments that can improve the quality of life of these patients.7

Furthermore, while half and half nails is the onychopathy most characteristic of patients on hemodialysis, we would assert that this condition is not, as stated by Robles-Méndez et al., specific to uremia because in a case control study we observed it in 3% of the controls.8

In another study with multivariate analysis, we also observed that long term hemodialysis for CDK accelerated skin aging in that the presence of markers of skin aging increased in relation to the time on hemodialysis, independent of age.9 It has recently been observed that uremia and aging share many pathophysiological characteristics, which could be explored to identify future therapeutic strategies.10

Consequently, we believe that it is necessary to combine our efforts and continue investigating potential new remedies to alleviate the cutaneous manifestations of chronic kidney disease.