CKD-aP in focus: A comprehensive guide from recognition to relief for local practice

Introduction Chronic kidney disease-associated pruritus (CKD-aP) affects up to 50% of dialysis patients and significantly impairs quality of life. Despite its prevalence and impact, CKD-aP remains under-recognized and undertreated in clinical practice. Methods A narrative review was conducted using PubMed, Scopus, and Google Scholar. Studies were selected based on clinical relevance, methodological rigor, and focus on validated patient-reported outcome measures (PROMs) and therapeutic trials, particularly involving gabapentinoids and κ-opioid receptor agonists. Key topics were reviewed jointly by nephrology and dermatology specialists, who collaborated to develop a synthesized management algorithm and treatment summary table through expert discussion. Results This interdisciplinary review provides an overview of CKD-aP pathophysiology (Figure 1) and outlines a diagnostic algorithm (Figure 2) incorporating symptom screening, exclusion of differential diagnoses, and PROM-based severity assessment. A stepwise treatment approach is presented (Figure 3), beginning with emollients, followed by gabapentinoids, and advancing to difelikefalin—the first FDA (United States), EMA (European Union) and HSA (Health Sciences Authority) of Singapore-approved treatment for moderate-to-severe CKD-aP. The review is designed as a user-friendly resource for clinicians and nurses, regardless of their specialty background. Conclusion CKD-aP is a complex and distressing condition requiring greater awareness and multidisciplinary care. While effective therapies like difelikefalin exist, their use is limited by cost and unfamiliarity. Future priorities should include improving access, comparing available treatments, exploring alternative drug delivery routes, and integrating quality-of-life assessments into routine care.