Uremic pruritus remains a frequent concern for hemodialysis patients with the most frustrating and disabling symptoms. The word uremic may denote that patients suffer from acute renal injury. Hence it is preferred to use the recent term "chronic kidney disease associated pruritus" (CKD-associated pruritus). The prevalence of CKD-associated pruritus in patients ranges from 15%-90% in various studies.Interestingly, in CKD associated pruritus the skin lesions are not found. The various skin lesions which range from excoriations, impetigo, linear crusts, papules and ulcers are secondary. Other co-existing diseases like cardiovascular diseases, diabetes, hypothyroidism, chronic liver or hematological diseases may challenge the diagnosis and management.The pathophysiology remains unexplained. There may be an imbalance between the antagonistic activities of µ-and] κ-opioid receptors. Itch sensation are correlated with the activation of certain areas in the brain, spatial and temporal aspects may be processed in the primary somatosensory cortex, planning of scratch response in the pre-motor and supplementary motor cortices, and affective and motivational aspects in the anterior cingulate cortex.