Mucocutaneous manifestations in chronic kidney disease (CKD) are common, heterogeneous, and frequently underrecognized, spanning from xerosis and pruritus to severe entities such as calciphylaxis, as well as disorders of skin pigmentation, nail changes, and hair-growth abnormalities. Their pathophysiology reflects a convergence of epidermal barrier dysfunction, accumulation of uremic toxins, systemic inflammation, perturbations of the endogenous opioid axis, anemia, and mineral-bone disorder. Early pattern recognition improves care and guides a multimodal management strategy focused on reducing uremia through optimized dialysis and metabolic control, intensive emollient therapy and photoprotection, phototherapy, neuromodulatory agents, and—when appropriate—κ-opioid receptor modulators. Close collaboration between nephrology and dermatology, use of validated severity scales, and standardized follow-up can alleviate symptoms, lower complication rates, and potentially improve survival. Concurrently, there is a pressing need for robust cutaneous biomarkers and pragmatic trials evaluating real-world intervention bundles.
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