Prognostic Significance of Chronic Kidney Disease-Associated Pruritus: A Systematic Review and Meta-analysis of Mortality, Hospitalization, and Dialysis-Related Outcomes

Chronic kidney disease-associated pruritus (CKD-aP), historically termed uremic pruritus, is a common and burdensome symptom in patients with advanced chronic kidney disease, hemodialysis, and peritoneal dialysis. Although previous reviews have emphasized prevalence, sleep disturbance, psychological burden, treatment response, and health-related quality of life, the prognostic significance of CKD-aP for hard clinical outcomes remains uncertain. We systematically reviewed studies published from January 1, 2000 to May 31, 2026 that evaluated CKD-aP or itch as a prognostic exposure in adults with chronic kidney disease or kidney failure. Outcomes included all-cause mortality, hospitalization, cardiovascular outcomes, infection-related outcomes, peritoneal dialysis outcomes, dialysis-related outcomes, and healthcare utilization. Risk of bias was assessed using QUIPS, and comparable adjusted hazard ratios for all-cause mortality in hemodialysis cohorts were pooled using DerSimonian-Laird random-effects models, with REML Hartung-Knapp analyses used for robustness. Proxy exposure studies, composite endpoints, and non-comparable effect measures were excluded from the primary quantitative model. Twenty-two reports were retained. In the primary model, severe or extreme CKD-aP was associated with higher all-cause mortality among hemodialysis patients (2 studies; pooled HR 1.33, 95% CI 1.07-1.65; I2 = 39.6%). A sensitivity model including one additional cohort showed a similar association (HR 1.42, 95% CI 1.12-1.80; I2 = 44.7%), although Hartung-Knapp intervals were imprecise and crossed the null. Secondary clinical outcomes were relevant but heterogeneous and were synthesized narratively. Severe CKD-aP may identify higher-risk hemodialysis patients, but certainty of evidence remains low. These findings should be interpreted cautiously in clinical practice and research.