Chronic renal failure (CRF) is frequently associated with a wide range of cutaneous manifestations resulting from metabolic disturbances, toxin accumulation, and treatment-related factors. This study aimed to compare the prevalence and characteristics of dermatological manifestations in patients with CRF undergoing hemodialysis and those not yet on dialysis. A cross-sectional observational study was conducted on 120 adult patients diagnosed with CRF, divided into two groups: 60 receiving maintenance hemodialysis for at least six months and 60 managed conservatively without dialysis. Detailed dermatological examinations were performed by certified dermatologists, and relevant biochemical parameters, including serum urea, creatinine, calcium, and phosphate levels, were recorded.

The most common skin manifestations observed across both groups included xerosis (78.3%), pruritus (62.5%), and pigmentary changes (51.7%). However, the prevalence and severity of these findings were significantly higher among dialysis patients (p < 0.05). Specific features such as uremic frost, half-and-half nails, and acquired perforating dermatosis were observed exclusively or more frequently in the hemodialysis group. In contrast, early-stage manifestations like pallor and mild xerosis predominated among nondialysis patients. Correlation analysis revealed that higher serum phosphate and longer dialysis duration were significantly associated with pruritus intensity and the presence of perforating disorders.