Virgin Coconut Oil as a Topical Intervention for Uremic-Associated Xerosis and CKD-Associated Pruritus: A Systematic Review

Abstract

Context: Chronic kidney disease-associated pruritus (CKD-aP) and uremic xerosis affect more than half of patients undergoing hemodialysis (HD) and markedly impair their quality of life. Conventional moisturizers often provide insufficient relief. Virgin coconut oil (VCO), possessing emollient, antimicrobial, and anti-inflammatory properties, has been proposed as a low-cost topical therapy. However, its effectiveness in CKD-specific dermatoses has not been comprehensively evaluated. Objectives: The objective of this study is to systematically review the evidence on the efficacy, safety, and feasibility of topical VCO for managing uremic xerosis and CKD-aP in adults. Methods: A systematic search of PubMed, Scopus, Embase, Google Scholar, and SciSpace (from inception to November 2025) identified studies assessing topical VCO for xerosis or pruritus in CKD. Two reviewers independently performed screening, data extraction, and quality appraisal using the Joanna Briggs Institute (JBI) checklist. Due to heterogeneity in study designs, comparators, and outcomes, findings were synthesized narratively. Results: Eighty-three records were identified, and 12 studies met the inclusion criteria: One randomized controlled trial (RCT), four quasi-experimental controlled studies, and seven uncontrolled pre-post studies (total ≈ 350 participants). The RCT (n = 60) showed significantly greater improvement in overall dry skin score (ODSS) with VCO compared to mineral oil after one week of twice-daily application (P < 0.05). Quasi-experimental studies reported consistent within-group improvements in skin moisture and pruritus scores [5-D Itch Scale, Visual Analog Scale (VAS)], though results versus standard lotions were variable. Uncontrolled studies uniformly demonstrated reductions in xerosis and pruritus but were limited by small samples and lack of control groups. No serious adverse events were reported, although adverse event monitoring was inconsistently described. The overall certainty of the evidence was low to moderate due to methodological limitations, short follow-up, and heterogeneous outcome measures. Conclusions: Topical VCO appears safe and potentially effective for short-term relief of uremic xerosis and CKD-aP, particularly in low-resource settings. Robust, long-term randomized trials using standardized outcomes are needed to confirm comparative effectiveness and define optimal application protocols.