Uremic pruritus affects a large share of hemodialysis patients and had no approved treatment, leaving clinicians to rely on antihistamines and off-label agents. Korsuva (difelikefalin) filled that gap.
Difelikefalin is the first selective kappa opioid receptor agonist approved, acting on peripheral nerves and immune cells without meaningfully entering the brain. It is given intravenously at the end of each dialysis session for moderate-to-severe pruritus associated with chronic kidney disease in adults on hemodialysis.
Korsuva remains marketed, but its commercial performance was constrained by CMS bundling dialysis drugs into the ESRD payment system, and the asset was consolidated under CSL Vifor in late 2024. It is a cautionary reference for reimbursement risk in dialysis-administered therapies.
