Gabapentin and Pregabalin Use and Association with Adverse Outcomes among Hemodialysis Patients

Ishida, Julie H.; McCulloch, Charles E.; Steinman, Michael A.; Grimes, Barbara; Johansen, Kirsten L.

doi:10.1681/asn.2018010096

Cited by 104 publications

(78 citation statements)

References 52 publications

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“…A total of 17 journal articles were identified and assessed for eligibility. Nine were excluded because of the following reasons: one was a pilot study, two were reviews, two were retrospective studies, one was a protocol, one was a correspondence letter, and three were nonrandomized clinical trials (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

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Gabapentin for uremic pruritus: a systematic review of randomized controlled trials

2019

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Uremic pruritus is one of the most prevalent and bothersome dermatologic symptoms in patients with end‐stage renal disease. Some studies suggest a possible neuropathic cause of uremic pruritus. Gabapentin, an anticonvulsant, may control pruritus with neuropathic origin. The objectives of this study were to assess the efficacy of gabapentin in reducing pruritus scores of patients with uremic pruritus and evaluate its safety among dialysis patients. Meta‐analysis of randomized controlled trials, using gabapentin as treatment for uremic pruritus among hemodialysis patients was included and analyzed using Review Manager Version 5.1.4 software. Seven out of 17 screened articles were included, with a total of 315 participants. Meta‐analysis of the incidence of improved pruritus scores after treatment from four studies (n = 171) showed that treatment with gabapentin decreased the severity of uremic pruritus as compared to the placebo (risk ratio = 0.18; 95% confidence interval: 0.09, 0.33; I2 = 4%: P =< 0.00001). Six studies (n = 290) presented with incidence of adverse drug events such as dizziness, drowsiness, and somnolence. In the pooled analysis, treatment with gabapentin was associated with a higher incidence of adverse drug events compared to the comparator drugs, but the results were not significant (risk ratio = 1.3, 95% confidence interval: 0.81, 2.11; P = 0.28, I2 = 37%). The results of this systematic review suggest that gabapentin is efficacious and safe in improving uremic pruritus among dialysis patients.

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Section: Resultsmentioning

confidence: 99%

“…one was a pilot study, 4 two were reviews, 8,11 two were retrospective studies, 12,13 one was a protocol, 14 one was a correspondence letter, 15 and three were nonrandomized clinical trials [16][17][18] (Fig. 1).…”

Section: Study Selectionmentioning

confidence: 99%

Gabapentin for uremic pruritus: a systematic review of randomized controlled trials

2019

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“…These concerns have been highlighted in clinical guidelines, which have advocated conservative dosing [39]. This is also an issue given studies which document prescription at higher doses than recommended [23]. Pregabalin, an anticonvulsant indicated to treat neuropathic pain, has also been associated with neurotoxicity in patients with chronic kidney disease [40,41].…”

Section: Discussionmentioning

confidence: 99%

“…Concerns over gabapentinoid abuse and risks of toxicity among ESRD patients have been raised previously [21,22]. Ishida et al [23] reported prescription of gabapentinoids was common in ESRD patients and associated with altered mental status and falls. We showed prescription of gabapentin to dialysis patients with a diagnosis of seizures or epilepsy was associated with increased mortality [24].…”

Section: Introductionmentioning

confidence: 99%

Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

et al. 2020

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Background: The opioid epidemic is a public health emergency and appropriate medication prescription for pain remains challenging. Physicians have increasingly prescribed gabapentinoids for pain despite limited evidence supporting their use. We determined the prevalence of concomitant gabapentinoid and opioid prescriptions and evaluated their associations with outcomes among dialysis patients. Methods: We used the United States Renal Data System to identify patients treated with dialysis with Part A, B, and D coverage for all of 2010. Patients were grouped into 4 categories of drugs exposure status in 2010: (1) no prescriptions of either an opioid or gabapentinoid, (2) ≥1 prescription of an opioid and no prescriptions of gabapentinoids, (3) no prescriptions of an opioid and ≥1 prescription of gabapenbtinoids, (4) ≥1 prescription of both an opioid and gabapentinoid. Outcomes included 2-year all-cause death, dialysis discontinuation, and hospitalizations assessed in 2011 and 2012. Results: The study population included 153,758 dialysis patients. Concomitant prescription of an opioid and gabapentin (15%) was more common than concomitant pre-scription of an opioid and pregabalin (4%). In adjusted analyses, concomitant prescription of an opioid and gabapentin compared to no prescription of either was associated with increased risk of death (hazard ratio [HR] 1.16, 95% CI 1.12-1.19), dialysis discontinuation (HR 1.14, 95% CI 1.03-1.27), and hospitalization (HR 1.33, 95% CI 1.31-1.36). Concomitant prescription of an opioid and pregabalin compared to no prescription of either was associated with increased mortality (HR 1.22, 95% CI 1.16-1.28) and hospitalization (HR 1.37, 95% CI 1.33-1.41), but not dialysis discontinuation (HR 1.13, 95% CI 0.95-1.35). Prescription of opioids and gabepentinoids compared to only being prescribed opioids was associated with higher risk of hospitalizations, but not mortality, or dialysis discontinuation. Conclusions: Concomitant prescription of opioids and gabapentinoids among US dialysis patients is common, and both drugs have independent effects on outcomes. Future research should prospectively investigate the potential harms of such drugs and identify safer alternatives for treatment of pain in end-stage renal disease patients. cancer, whether patients had at least one pain-related hospitalization and the number of hospitalizations in 2010 [6,8].

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“…Similarly, pregabalin in doses of up to 100 and ˃ 100 mg/d increased the likelihood of altered mental status issues by 51% and 46% of patients, respectively. Gabapentin was more commonly prescribed (19%) than was pregabalin (4%) …”

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confidence: 99%

Briefly Noted

Sherman¹

2019

Seminars in Dialysis

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Gabapentin and Pregabalin Use and Association with Adverse Outcomes among Hemodialysis Patients

Cited by 104 publications

References 52 publications

Gabapentin for uremic pruritus: a systematic review of randomized controlled trials

Gabapentin for uremic pruritus: a systematic review of randomized controlled trials

Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

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