Itching in Kidney Disease: Why It Happens and How It’s Managed

That persistent, bothersome itch could be more than just dry skin. When kidney problems cause itching (CKD-associated pruritus), it can severely affect your sleep and mood. The first step is simple: fight dryness with daily moisturizing! If that doesn't help, talk to your nephrologist about effective prescription treatments.

Itchy skin is one of the most common—and most bothersome—symptoms of chronic kidney disease (CKD). When this itching is directly linked to kidney problems, it is called CKD-associated pruritus (CKD-aP) or uremic pruritus. Studies show that up to 40–70% of people with advanced CKD or those on dialysis experience this symptom. For many, it is more than a nuisance: itching can interfere with sleep, mood, and overall quality of life.

Why Does Itching Happen in CKD?

The exact cause of CKD-related itching is complex and involves many overlapping factors:

• Dry skin (xerosis): One of the most important and overlooked contributors. Reduced sweat and oil gland activity in CKD leads to skin barrier damage, which worsens itching.

• Build-up of waste products: Uremic toxins can irritate nerves and skin.

• Mineral imbalances: High calcium, phosphorus, or parathyroid hormone levels may trigger itching.

• Inflammation: CKD often causes chronic, low-grade inflammation that affects the skin.

• Nerve changes: Neuropathy and altered nerve signaling play a role.

• Other risks: Older age, diabetes, viral hepatitis, smoking, and depression can all increase the chance of itching.

Who Is Most at Risk?

• People with advanced CKD (stage 4–5)

• Patients on dialysis (especially hemodialysis)

• Individuals with diabetes, obesity, hepatitis, or high parathyroid hormone

• In dialysis, moderate-to-severe itching is seen in 40–70% of patients; in non-dialysis CKD, it affects about 25–35%, increasing with advancing disease.

How Is It Treated?

Combatting itching in kidney disease often starts with good skincare. Regularly moisturizing with fragrance-free creams, especially after bathing, is a simple yet powerful step to soothe dry, irritated skin and find significant relief from CKD-associated pruritus

Because many factors contribute to itching, treatment usually involves more than one approach.

1. Start with Skin Care – The First Line of Defense

• Daily moisturizers and emollients are essential. Dry skin is nearly universal in CKD, and simply restoring skin hydration can dramatically improve itching.

• Choose fragrance-free creams or ointments (rather than lotions) for best results.

• Apply immediately after bathing to lock in moisture.

2. Topical Therapies

• Cooling or soothing creams with menthol, camphor, or pramoxine may help.

• Avoid hot showers and harsh soaps, which worsen dryness.

3. Medications for Moderate to Severe Itch

• Gabapentin or pregabalin: Effective, especially in dialysis patients.

• Difelikefalin (IV): FDA-approved for hemodialysis patients.

• SSRIs (such as sertraline): May help in both dialysis and non-dialysis CKD.

• Other options for resistant cases include montelukast, thalidomide, or phototherapy.

4. Correcting Underlying Issues

• Optimizing dialysis treatment

• Managing high calcium, phosphorus, or parathyroid hormone levels

Key Takeaway

Itching in kidney disease is more than just “dry skin”—but dryness is one of the biggest drivers and should always be addressed first. Daily use of emollients and moisturizers is the cornerstone of care and can provide meaningful relief for many patients. If itching continues despite good skin care, effective medications and other treatments are available.

👉 If itching is affecting your sleep, mood, or quality of life, talk to your nephrologist about next steps.