Prevalence and associated factors of chronic kidney disease-associated pruritus in maintenance hemodialysis patients: a systematic review and meta-analysis.

Abstract

Background: Chronic kidney disease-associated pruritus (CKD-aP) is a common and burdensome complication in patients undergoing maintenance hemodialysis (MHD). However, reported prevalence and associated factors remain inconsistent across studies.

Methods: In accordance with PRISMA 2020 guidelines, we systematically searched eight electronic databases from inception to March 11, 2026 for observational studies reporting prevalence and/or associated factors of pruritus in adult MHD patients. Only multivariable-adjusted odds ratios were included in analyses of associated factors. Continuous and dichotomised estimates were analysed separately, and sensitivity analyses restricted to high-quality studies were performed where feasible.

Results: A total of 25 studies involving 8,955 participants were included. The pooled prevalence of any pruritus among MHD patients was 60.0% (95% CI: 57.0-63.0%). Serum phosphorus was positively associated with pruritus in both continuous (OR = 2.03, 95% CI: 1.44-2.87) and dichotomised analyses (OR = 2.93, 95% CI: 1.83-4.69), although substantial heterogeneity remained in the continuous analysis. Associations for PTH/iPTH, CRP, β₂-microglobulin, dialysis vintage, and age varied according to variable definition and/or study quality. Diabetes mellitus was associated with higher odds of pruritus (OR = 2.64, 95% CI: 1.69-4.14), whereas high-flux hemodialysis showed an inverse association (OR = 0.31, 95% CI: 0.17-0.56). Exploratory meta-regression among continuous phosphorus studies suggested regional variation (P = 0.002), with a stronger association in Asian than non-Asian studies; however, only two non-Asian studies were available.

Conclusions: Approximately 60% of patients undergoing MHD experience pruritus. Serum phosphorus showed the most consistent association with CKD-aP, whereas estimates for several other factors varied according to variable definition, methodological quality, and between-study heterogeneity. The observed regional variation in the phosphorus-pruritus association should be regarded as hypothesis-generating. Standardised exposure definitions and prospective studies are needed to clarify these associations.

Trial registration: This study was registered in the PROSPERO platform (CRD420261337554).

Clinical trial number: Not applicable.