Among the many difficult symptoms that patients with kidney disease experience, pruritus is one of the most frequent and troubling. Because a substantial amount of new information has accumulated, we seek here to review the subject.

Pruritus is not only a common problematic symptom among patients with kidney disease, but its considerably more frequent than nephrologists recognize. The result for patients is not just uncomfortable itch but degraded quality of life as well. The pathogenesis is increasingly understood, but many aspects remain to be fully resolved. Importantly, research is progressing on treatment, leading to the first approved medication in the United States, difelikefalin, in August, 2021.

As nephrology is progressing to a greater focus on patient symptoms, recognition of the importance of pruritus has led to increased interest and improved diagnosis and treatment options.