Most CKD patients on hemodialysis reported suffering from CKD-aP1

of HD patients in
the U.S. reported that
suffered from CKD-aP


of HD patients
the U.S. were
to extremely
bothered by itch

CKD-aP=chronic kidney disease–associated pruritus; CKD=chronic kidney disease; HD=hemodialysis.

*Phases 4–6 of DOPPS (a prospective cohort study) included 34,694 HD patients in 21 countries from 2009–2018; 23,264 patients were eligible for analysis of the primary outcome. The primary clinical outcome was time to all-cause mortality; dialysis-related outcomes included withdrawal from dialysis and missed HD sessions; patient-reported outcomes included measure of health-related quality of life, depression, and sleep quality.

Figure calculated based on total patients reporting being somewhat to extremely bothered by itching.

Hear from an expert

Watch this video featuring Dr. Stephen Fishbane that discusses the prevalence of CKD-aP in patients on
hemodialysis, as well as how to identify and assess the severity of CKD-aP in these patients.

This is an actual treating physician who was compensated for his time and consents to this use. Nothing in this video or website constitutes medical advice or treatment guidance.

More information about the expert

Stephen Fishbane, MD

Nephrologist, Great Neck, NY
Member, ASN, NKF, RPA

Hemodialysis patients may not always report their itching, and rates of CKD-aP may be underestimated2

of medical directors
underestimated the
prevalence of CKD-aP
in their facilities2


of U.S. patients who were
always or always
bothered by
itching did not
report it to any

Clinical variability may make diagnosis of CKD-aP challenging3
Variable severity
  • ​​​​​​Severity of patient-reported itch may vary over time—it may be intermittent or persistent, and may occur anytime in relation to dialysis—before, during, or after3
Generalized or localized
  • When CKD-aP is generalized, it is often symmetrical—however, when it is localized, it often occurs on the face, back, and shunt arm only3
Environmental and activity-based factors
  • Extreme hot or cold, stress, physical activity, and showering have been reported by patients to worsen CKD-aP4
Visible variability
  • CKD-aP may occur without any skin manifestations, can coexist with xerosis, and can occur with superimposed complications of itching, including crusts and ulcerations3

Because this is a common condition in hemodialysis patients,
any sign of itching may be related to CKD-aP3

CKD-aP=chronic kidney disease–associated pruritus.

*Phases 1–5 of DOPPS (a prospective cohort study) included 51,062 HD patients in 21 countries from 1996–2015; 35,452 patients answered the question regarding how bothered they were by itchy skin in a questionnaire and were included in this analysis.

  1. Sukul N, Karaboyas A, Csomor PA, et al. Self-reported pruritus and clinical, dialysis-related, and patient-reported outcomes in hemodialysis patients. Kidney Med. 2020;3(1):42–53. doi:10.1016/j.xkme.2020.08.011
  2. Rayner HC, Larkina M, Wang M, et al. International comparisons of prevalence, awareness, and treatment of pruritus in people on hemodialysis. Clin J Am Soc Nephrol. 2017;12(12):2000–2007. doi:10.2215/CJN.03280317
  3. Verduzco HA, Shirazian S. CKD-associated pruritus: new insights into diagnosis, pathogenesis, and management. Kidney Int Rep. 2020;5(9):1387–1402. doi:10.1016/j.ekir.2020.04.027
  4. Combs SA, Teixeira JP, Germain MJ. Pruritus in kidney disease. Semin Nephrol. 2015;35(4):383–391. doi:10.1016/j.semnephrol.2015.06.009
  5. Ramakrishnan K, Bond CT, Claxton A, et al. Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms. Int J Nephrol Renovasc Dis. 2014;7:1–12. doi:10.2147/IJNRD.S52985