If you’re living with chronic kidney disease (CKD), you're probably already familiar with its impact on your energy, fluid balance, and diet. But there’s one symptom that often catches people off guard: relentless itching.

This persistent itch—known as CKD-associated pruritus—can interfere with sleep, concentration, and overall quality of life. And if you’ve found yourself scratching without relief, you’re not alone. According to a 2022 study published in Kidney International Reports, up to 40% of people with end-stage kidney disease (ESKD) experience moderate to severe itching, often on a daily basis.

So, what’s behind this frustrating symptom—and more importantly, what can be done about it?

What Causes the Itching in CKD?

Researchers believe CKD-related itch stems from multiple overlapping causes, not just one. Here are the most common culprits:

• Toxin Buildup: As kidney function declines, waste products like urea accumulate in the blood and may irritate the skin and nerves.
  

• Mineral Imbalances: High levels of phosphorus or parathyroid hormone (PTH) are known to irritate nerve endings and contribute to itch.
  

• Inflammation: Chronic inflammation—common in CKD—can activate nerve pathways associated with itching.
  

• Dry Skin (Xerosis): Many people with CKD experience dry, flaky skin, which naturally makes itching worse.
  

• Nerve Sensitivity: Damage to small nerve fibers or changes in how the brain processes itch signals can also play a role.

CKD-associated pruritus is a complex condition influenced by both physical and biochemical factors—and managing it often requires a multi-faceted approach.

Learn how to check kidney function at home to stay proactive with your health.

When itching starts: CKD stages and risk

You can develop itching at any point in your CKD journey, but it becomes more common in the later stages.

• Stage 1–2: Rare, though dry skin may start to appear.
  

• Stage 3–4: Around 20% of people begin to notice itchiness, especially if phosphorus levels rise.
  

• Stage 5 (kidney failure): Up to 70% of people on dialysis report significant itching, according to the DOPPS study published in 2021.
  

If you’re on hemodialysis and feeling itchy, you’re not alone—and you don’t have to live with it.

Learn more about the stages of chronic kidney disease and associated symptoms that can trigger skin issues like itching.

What CKD-related itching feels like

CKD-related itching (also called uremic pruritus) often shows up in subtle but frustrating ways:

• Itching without a rash, though chronic scratching may cause skin damage

• Worse at night, which can affect your sleep

• Dry, scaly, or flaky skin, especially on your arms, back, or abdomen

• Itching on both sides of your body, not just one area

• Mood changes, like anxiety or low mood, due to constant discomfort

According to the National Kidney Foundation, many people describe it as “deep,” “uncontrollable,” or “burning.”

Stage 2 kidney disease life expectancy helps you understand early signs of kidney dysfunction before symptoms escalate.

What treatments can help

There isn’t one magic solution—but there are a range of therapies that can ease your symptoms and improve your quality of life. Most people benefit from a combination of skincare, medication, and managing kidney health overall.

 Explore at-home kidney health tests to support personalized treatment options.

Step 1: Moisturize and soothe your skin

Dry skin makes everything worse. Start with a strong daily moisturizing routine:

• Use fragrance-free lotions or ointments (avoid anything with alcohol or perfumes).

• Apply twice daily, especially after showering.

• Try colloidal oatmeal baths or cool compresses for relief during flare-ups.

• Use lukewarm water—hot water strips natural oils from your skin.

According to the American Academy of Dermatology (AAD), consistent moisturizing is one of the most effective ways to reduce itching related to CKD.

Check what your urine color says about hydration and its role in skin dryness.

Step 2: Review your dialysis and labs

Sometimes, itching improves when dialysis is more efficient.

Ask your care team to review:

• Kt/V or URR scores - measurements that asses dialysis adequecy  (these measure dialysis adequacy)

• Serum phosphorus and calcium levels

• Parathyroid hormone (PTH) values

According to a 2021 review in Clinical Kidney Journal, people with better-controlled mineral levels report less itching.

You may benefit from:

• Adjusting your dialysis schedule or filter

• Taking phosphate binders with meals

• Making low-phosphorus diet changes

Step 3: Use prescription treatments if needed

If skincare and dialysis changes aren’t enough, your provider may recommend medications. These include both topical and systemic (whole-body) treatments.

Topical options:

• Pramoxine cream: Numbs nerves in the skin and offers temporary relief.

• Menthol or calamine lotions: Create a cooling sensation that soothes the itch.

• Capsaicin cream: May help when itching is localized.

• Corticosteroid creams: Useful if inflammation is visible—but not for long-term use.
  
  

Oral or injectable medications:

• Gabapentin or pregabalin: Help calm overactive nerve signals. Often used at low doses post-dialysis.

• Difelikefalin (Korsuva®): FDA-approved injection for people on dialysis. Works on kappa-opioid receptors to reduce itch.

• Nalfurafine: A kappa-opioid receptor medication used in Japan.

• Sertraline (SSRI): Sometimes used if itching causes emotional distress or overlaps with depression.

According to a 2021 randomized trial published in The New England Journal of Medicine, 51% of patients using difelikefalin reported significant relief after just four weeks.

Step 4: Consider UV light therapy

Narrowband UV-B phototherapy is a safe and effective option when other treatments haven’t helped.

• Done 2–3 times per week at a dermatologist’s office

• Often improves itch within a few weeks

• Requires regular maintenance

According to a 2020 Cochrane review, over 60% of people with uremic itch found relief with this therapy.

Step 5: Kidney transplant

While it’s not an option for everyone, a successful kidney transplant often resolves itching entirely.

In one study, up to 75% of transplant recipients reported their pruritus stopped after surgery. That’s because the new kidney can better filter toxins and balance minerals.

Read about life after transplant and how to protect your kidneys.

What you can do at home

You can take steps every day to ease symptoms:

• Use gentle, unscented soaps and detergents
  

• Keep your home humidified in dry weather
  

• Avoid tight or scratchy clothing
  

• Keep nails short to prevent skin injury
  

• Track your symptoms to see what makes them better or worse
  

• Reduce stress with mindfulness, deep breathing, or talking to a counselor
  

These small steps add up and can make a noticeable difference.

Track your kidney labs at home

Did you know that phosphorus, calcium, and PTH levels may influence itching? Ribbon Checkup offers at-home kidney health tests that let you keep tabs on key parameters between visits.

This gives you and your doctor a better view of what’s going on—and helps you take action early.

Takeaway

Itching from kidney disease isn’t just “dry skin.” It’s a real, medically recognized symptom that can impact sleep, mood, and daily life. But there’s hope.

You can manage CKD-related itching with:

• Skincare and moisturizing routines

• Dialysis adjustments and lab management

• Targeted medications like gabapentin or difelikefalin

• Advanced therapies like phototherapy or transplant

The earlier you speak up about your symptoms, the more options you have to feel better.

Written by Abel Tamirat, MD
Dr. Abel Tamirat is a licensed General Practitioner and ECFMG-certified international medical graduate with over three years of experience supporting U.S.-based telehealth and primary care practices. As a freelance medical writer and Virtual Clinical Support Specialist, he blends frontline clinical expertise with a passion for health technology and evidence-based content. He is also a contributor to Continuing Medical Education (CME) programs.

References

Burton, J. O., Walpen, S., Danel, S., & Bernd Schröppel. (2023). Current Practices in CKD-Associated Pruritus: International Nephrologist Survey. Kidney International Reports, 8(7), 1455–1459. https://doi.org/10.1016/j.ekir.2023.04.003 

Cheng, A.-Y., & Wong, L.-S. (2022). Uremic Pruritus: From Diagnosis to Treatment. Diagnostics, 12(5), 1108–1108. https://doi.org/10.3390/diagnostics12051108 

Clinic, C. (2023, June 5). Uremic Pruritus: Causes, Symptoms, Diagnosis & Treatment. Retrieved June 10, 2025, from Cleveland Clinic website: https://my.clevelandclinic.org/health/symptoms/25049-uremic-pruritus 

Nwamaka Osakwe, & Hashmi, M. F. (2024, August 8). Uremic Pruritus Evaluation and Treatment. Retrieved June 10, 2025, from NIH.gov website: https://www.ncbi.nlm.nih.gov/books/NBK587340/ 

Pruritus (Itchy Skin). (2025, June 3). Retrieved June 10, 2025, from National Kidney Foundation website: https://www.kidney.org/kidney-topics/pruritus-itchy-skin 

UpToDate. (2025). Retrieved June 10, 2025, from Uptodate.com website: https://www.uptodate.com/contents/chronic-kidney-disease-associated-pruritus