Research on kidney disease–associated pruritus has been invigorated by renewed focus on patient-centered care, patient prioritization of symptom-related research, and the introduction of difelikefalin, the first new medication for the treatment of dialysis-related symptoms in years. Yet, many unanswered questions remain regarding its optimal management. Importantly, the cause of kidney disease–associated pruritus, specifically the role of dialysis kinetics and mineral metabolism, remains uncertain.