Pruritus a common problem in dialysis patients, is sometimes precipitated or exacerbated by dialysis. Pruritus appearing only during treatment, especially if accompanied by other allergic symptoms, may be a manifestation of low grade hypersensivity to dialyser or blood circuit components. More often than not, however, pruritus is simply present chronically and is noticed in the course of the treatment while the patient is forced to sit still for a prolonged period of time. Viral or drug induced hepatitis should be overlooked as a potential cause of such itching. Standard symptomatic treatment using antihistamines are useful. Odansetron and naltroxan have failed to help in randomized trials. Acupuncture has helped chronically, general moisturizing and lubrication of skin using emollients recommended. Ultraviolet light therapy, especially UVB light, may be of help. Pruritus often is found in patient with elevated serum ca*p product and or substantially elevated PTH level. Reduction in ca, p, and PTH are indicated. Whether uremic pruritus is helped by an increase dose of dialysis, use of high flux or polymethylacrylate membrane, capsaicin cream and activated charcoal, tacrolimus ointment or erythropointin remain question for further investigations. Because uremic pruritus is common in 42-75 of hemodialysis patients and accompanied with sleep disorder, depression, disturbed quality of life and mortality, treatment is important. 50 patients chronically hemodialysed that dialysed 3 per week and have chronic pruritus more than 4 weeks selected. They should not use antihistamin, lubricantor gabapenthin. Randomly half of them take sertraline 50 mg 2 times per day and half take placebo. Pruritus evaluated in second, fourth, sixth and eighth week, scoring with DOU and VAS score done. In DOU evaluate severity, distribution and sleep disorder. In VAS we ask the patient that how much that feel pruritus and score from 1 to 10 and then sum DOU and VAS. In the beginning and end of study we check lab data: CBC, BUN, Cr, Na, K, AST, ALT, Ca, P, TG, CHOL, LDL, HDL, FBS, and PTH.