The prevalence of chronic kidney disease (CKD) and end-stage renal disease is increasing worldwide. Despite improvements in dialysis methods, including the development of novel biocompatible membranes and ultrapure dialysate, CKD-associated pruritus remains a common and significant public health issue. Not only does this distressing symptom profoundly impact on quality of life and sleep, recent evidence showed that pruritus also was associated with poor patient outcome. Nonetheless, nephrologists and other health care professionals often fail to recognize and adequately address the pruritus associated with CKD. The pathophysiological mechanism of CKD-associated pruritus is poorly defined, and, as a result, the development of specific therapies has proved to be a challenge. The purpose of this review is to highlight the importance of this neglected topic by providing an overview of recent epidemiological studies, outcomes data, proposed pathophysiological mechanisms, and emerging treatment options.