Effects of different complementary therapies on chronic kidney disease-associated pruritus: a systematic review and network meta-analysis.

Background: Chronic kidney disease-associated pruritus is one of the most common concomitant symptoms in patients with end-stage renal disease. It leads to multiple adverse outcomes for patients. Complementary therapies are increasingly used and represent an effective alternative approach. However, the optimal intervention method has not yet been clearly established. Objective: To compare the efficacy and safety of different complementary therapies in alleviating symptoms of chronic kidney disease-associated pruritus. Methods: A systematic search was conducted in 12 databases and relevant medical websites in accordance with the PRISMA-NMA guidelines. Randomized controlled trials published in the database from database inception through December 2025 were included. The Cochrane risk-of-bias tool for randomized trials (RoB 2.0) was used to assess the quality of the included literature. High-risk-of-bias studies were excluded and subsequently re-included in the sensitivity analysis. Statistical analysis was performed using Bayesian methods with the "gemtc" package and other R packages. The quality of evidence was assessed using the CINeMA online platform. Results: A total of 29 studies involving 12 complementary and alternative approaches and 1,968 patients were included. The network meta-analysis showed that Acupuncture (SMD = -2.12, 95% CI = -4.17 to -0.13; SUCRA = 0.80), Aromatherapy (SMD = -2.05, 95% CI = -4.00 to -0.08; SUCRA = 0.78), Herbal Medicinal Bath (SMD = -1.69, 95% CI = -2.67 to -0.71; SUCRA = 0.72) and Combination therapy (SMD = -1.47, 95% CI = -2.53 to -0.43; SUCRA = 0.65) were superior to the control group in improving pruritus symptoms. However, when the 9 excluded high-risk-of-bias studies were re-included in a sensitivity analysis, the effects of Acupuncture and other therapies were attenuated and no longer statistically significant. Only Herbal Medicinal Bath maintained a statistically significant and stable effect (SMD = -2.40, 95% CI = -3.60 to -1.21; SUCRA = 0.82). Conclusion: Based on the efficacy and stability of the current evidence, Herbal Medicinal Bath appears to be the most reliable complementary therapy. Acupuncture shows potential but requires further confirmation through more high-quality, large-scale randomized controlled trials. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261279443, identifier CRD420261279443.