Uremic pruritus (UP) stands as one of the most distressing symptoms experienced by dialysis patients. Its impact on their quality of life is profound, with a high prevalence among this population. Over 40% of hemodialysis patients endure chronic pruritus, with roughly half experiencing generalized itching. Despite ongoing research, the exact underlying mechanisms of chronic kidney disease-associated pruritus remain elusive. Pathogenesis has been linked to factors such as histamine, parathormone, magnesium, and calcium. Managing pruritus proves to be extremely challenging due to limited treatment options. Stepwise management strategies typically commence with the use of emollients, gabapentin, or phototherapy. In this lecture, I will present the evaluation, pathogenesis, and treatment for pruritus in dialysis patients, including the most recent updates.