**2. Clinical characteristics of CKD-associated pruritus**

In patients with CKD, skin lesions are usually not found. Generally, skin lesions are secondary changes such as excoriations with or without impetigo, linear crusts, papules, and ulcerations. Half of patients have generalized itching, and in the other half, pruritus is localized to the back, limbs, chest or head. Pruritus is intermittent or prolonged over hours and days, and becomes worse at night [18, 19]. Mettang & Krener [14] stated in their review that the diagnosis of uremic

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pruritus may be challenging because many patients with end-stage renal disease (ESRD) are suffering from other diseases, such as cardiovascular diseases, diabetes mellitus, chronic liver or hematological diseases, which may provoke itching either by itself or by medication given to treat these entities.
