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

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. 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. 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. 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. This study was registered in the PROSPERO platform (CRD420261337554). Not applicable. Uremic pruritus is a frequent and distressing complication in patients receiving maintenance hemodialysis. However, reported prevalence varies widely, and evidence regarding associated factors remains inconsistent. This systematic review and meta-analysis estimates a pooled prevalence of pruritus of approximately 60% in maintenance hemodialysis patients. It identifies serum phosphorus as a consistently associated factor and shows that estimates for several other factors vary according to variable definition and methodological quality. Exploratory meta-regression further suggests that study location may modify the phosphorus–pruritus association, although this regional finding should be considered hypothesis-generating.