OBJECTIVES: Itchy and dry skin, symptoms of pruritus, are commonly reported by patients with end‑stage renal disease (ESRD) and may impact health outcomes. However, the economic burden to dialysis facilities is poorly understood. This retrospective cohort study measured dialysis‑related costs in patients reporting itchiness/dryness at a large dialysis organization (LDO).  METHODS: Adult patients (≥ 18 years old) were identified in the LDO database if they responded to the Kidney Disease Quality of Life (KDQOL) survey administered between December 1, 2008 and June 30, 2012, which included questions about itchy/dry skin. Medicare patients were included if they answered a survey ≥ 3 months after dialysis initiation. Costs of medications, laboratories, and missed sessions were measured over a 6‑month follow‑up period. Patients were censored for death, transplant, change in treatment modality, discontinued treatment, or loss of observation. Mean utilization for medication and laboratory costs was determined by unit prices published in RED BOOK and physician fee and coding guide. Costs of missed sessions were derived by the standard 2012 Medicare composite reimbursement rate for in-center dialysis. Cost differences were determined by covariate adjusted generalized linear mixed models.   RESULTS: Over the 6‑month period, in unadjusted models (n = 38,815) increasing trends in total costs were observed with increasing severity of itchiness ($507, $803, $1,520, and $2,238) and dryness ($542, $840 $1,610, and $2,729) compared to no itchiness/dryness.  The adjusted model demonstrated similar trends, yet attenuated differences. A subgroup analysis comparing combined severe itchiness and dryness versus neither itchiness nor dryness showed a mean estimate of $2348 increased costs. All results were statistically significant (p