CKD-Associated Pruritus Affects 16.3% on Hemodialysis

Key Takeaways

• Among 294 eligible adults receiving maintenance haemodialysis at three dialysis centers affiliated with Başkent University Ankara Hospital in Turkey—after excluding patients with active dermatologic, hepatic or other systemic, malignant, infectious, or other acute causes of pruritus and those who had recently started a new systemic antipruritic treatment—34.4% reported any pruritus and 16.3% had moderate-to-severe CKD-associated pruritus.
• Most participants had no or mild itching, with a mean Five-D Itch Scale score of 8.00, and more severe symptoms were more common with comorbid chronic disease and prior pruritus-related education and less common among married participants.
• Interviews identified Pruritus Burden, Coping Mechanisms, Communication Barriers, and Care Expectations, with patients describing sleep disruption, emotional strain, stigma, and difficulty raising symptoms during routine care.
• Regular medication use for pruritus was reported by 72.1% of participants, yet 34% reported no treatment effect and only 9.2% reported receiving pruritus-related education.

Chronic kidney disease-associated pruritus can become normalized during haemodialysis even when it disrupts sleep, comfort, and social life. Persistent or fluctuating itching may go unreported when symptoms are minimized or when patients hesitate to interrupt busy care encounters. Pruritus in Turkish dialysis settings was examined in a mixed-methods assessment that measured how often symptoms occurred and how patients with more severe itching described living with it.

In Turkey, the Turgay and Özdemir Eler mixed-methods study of CKD-associated pruritus in haemodialysis used an explanatory sequential mixed-methods design across three dialysis centers affiliated with Başkent University Ankara Hospital. The quantitative phase included 294 adults receiving maintenance haemodialysis, and the qualitative phase included 48 participants with moderate-to-severe chronic kidney disease (CKD)-associated pruritus, defined as a Five-D Itch Scale score of 12 or higher. Data were collected from October 2025 through January 2026, and each qualitative participant completed at least two semi-structured interviews about symptom experience, coping, care encounters, and expectations.

Mean Five-D Itch Scale score was 8.00 ± 3.21. Severity distribution was 65.6% no pruritus, 18% mild, 12.6% moderate, and 3.7% severe.

Adjusted analysis linked married status with lower odds of moderate-to-severe pruritus (OR 0.418, 95% CI 0.202–0.867) and comorbid chronic disease (OR 2.399, 95% CI 1.126–5.112) and prior pruritus-related education (OR 3.145, 95% CI 1.258–7.859) with higher odds; sex and age were not significantly associated. Medication use was common, with oral antihistamines and creams or lotions most often used, but perceived benefit was often limited. The CKD-associated pruritus findings in adults receiving haemodialysis also identified four qualitative themes—Pruritus Burden, Coping Mechanisms, Communication Barriers, and Care Expectations—with patients describing fluctuating or persistent itching tied to sleep disruption, emotional strain, stigma, temporary relief from cooling or emollients, medication-related drowsiness or grogginess, risky self-care such as applying cologne, and hesitation to raise symptoms in busy care settings.

The authors said the Turkish setting and sampling from three dialysis centers should caution against assuming the same pattern in U.S. or Canadian haemodialysis populations. They also cited the cross-sectional quantitative design, self-reported measures, and a purposively selected qualitative subgroup with more severe symptoms, so those experiences may not extend to all haemodialysis patients. Excluding participants with documented psychiatric diagnoses or clinically evident psychiatric conditions may also have introduced selection bias and limited transferability to the broader haemodialysis population. In the authors' interpretation, the link between prior pruritus-related education and greater symptom severity most likely reflected reactive care delivery after symptoms had intensified rather than harm from education itself.

The authors concluded that chronic kidney disease-associated pruritus remained a multidimensional burden in haemodialysis care. Pairing prevalence estimates with patient accounts highlighted disrupted sleep, coping difficulties, communication barriers, and unmet expectations around care. The reported burden extended beyond symptom presence alone to how dialysis was experienced day to day.

Clinician Questions

How was moderate-to-severe CKD-associated pruritus defined in adults receiving haemodialysis?

The cohort used the Five-D Itch Scale, which ranges from 5 to 25 and classifies symptoms as no pruritus, mild, moderate, severe, or very severe; moderate-to-severe CKD-associated pruritus was defined as a total score of 12 or higher.

Which patients in this haemodialysis cohort were more likely to have moderate-to-severe CKD-associated pruritus after adjustment?

After adjustment, comorbid chronic disease and prior pruritus-related education were associated with a greater likelihood of moderate-to-severe CKD-associated pruritus, while married status was associated with lower odds and sex and age were not significantly associated. The authors suggested the education association most likely reflected patients receiving education after symptoms worsened rather than an adverse effect of education.

What kinds of coping problems and communication barriers did patients describe with CKD-associated pruritus during haemodialysis care?

Patients described temporary self-management with only partial relief, medication-related drowsiness or grogginess, risky skin practices such as applying cologne, and hesitation to mention itching when staff were busy or when symptoms were minimized as part of routine dialysis.