Clinical and Dermoscopic Nail Changes in Patients with Chronic Kidney Disease: A Cross-Sectional Study

Background: Nail abnormalities are commonly observed among patients with chronic kidney disease (CKD) and may reflect underlying systemic and metabolic alterations. Dermoscopy (Onychoscopy) has emerged as a valuable noninvasive tool for detecting subtle nail changes. Aim:  To describe the patterns and dermoscopic features of nail changes in patients with chronic kidney disease (CKD) and to explore their association with disease severity and renal function parameters. Methods: This cross-sectional descriptive study included 127 patients with different stages of CKD. All participants underwent a comprehensive clinical and dermoscopic evaluation of the nail apparatus. Dermoscopic findings included longitudinal ridging, white nails, half-and-half nails, absence of lunula, onycholysis, onychomycosis, splinter hemorrhages, and pitting. Statistical analysis was performed, and Bonferroni correction was applied to adjust for multiple comparisons. Results: Nail abnormalities were highly prevalent among patients with CKD. The most frequent dermoscopic findings were longitudinal ridging (99.2%) and absence of lunula (79.5%), followed by onycholysis (67.7%), half-and-half nails (50.4%), white nails (48%), and pitting (42.5%). Less frequent findings included splinter hemorrhages (15.7%), onychomycosis (12.6%), and nail discoloration (13.4%). Initial analysis suggested some associations between nail findings and clinical parameters; however, after Bonferroni correction, no significant associations were observed between nail manifestations and CKD stage or glomerular filtration rate (GFR). A statistically significant association persisted only between urea reduction ratio (URR) and nail pitting. Conclusion: Nail abnormalities were highly prevalent in this cohort of CKD patients; however, they do not appear to be significantly associated with disease severity after adjustment for multiple comparisons. These findings suggest that nail changes may reflect overall systemic burden rather than CKD progression. Onychoscopy enables detailed visualization of these changes and may serve as a useful noninvasive adjunctive tool in clinical assessment. However, controlled studies are needed to determine the specificity of these findings for CKD.