Chronic kidney disease-associated pruritus (CKD-aP) is a common yet long-overlooked complication among patients with end-stage renal disease. CKD-aP can significantly affect patients′ quality of life, sleep, and mood, reduce dialysis adherence, and is closely associated with an increased risk of mortality. In recent years, with deeper understanding of its pathogenesis and advances in the research and development of therapeutic drugs, CKD-aP has been redefined from a conventional accompanying "symptom" to an independent clinical disorder requiring active identification and systematic intervention. This article systematically reviewed CKD-aP from the perspectives of epidemiology, pathogenesis, diagnostic procedures, assessment scales, stratified management strategies, and advances in pharmaceutical research. It focuses on introducing the characteristics and clinical application value of various pruritus assessment tools as well as their applications in the research and development of κ-opioid receptor agonists, and discusses stratified management regimens based on pruritus severity. The aim is to improve clinicians′ ability to identify and standardly manage CKD-aP and improve patients′ prognosis.