Gabapentin for Uremic Pruritus in Hemodialysis Patients: A Qualitative Systematic Review

Abstract

Purpose of the reviewUremic pruritus (UP) is a common discomfort of dialysis-dependent end-stage renal disease. Some studies suggest a neuropathic cause of UP. Gabapentin, an anticonvulsant, has shown promising results as an emerging drug to treat this condition.ObjectiveAn updated qualitative systematic review was conducted to evaluate its efficacy and safety in hemodialysis patients.Source of informationOvid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and Google Scholar through June 2015 were used as sources of information.PatientsPatients are adult hemodialysis patients receiving gabapentin for UP.MethodsAll randomized controlled trials (RCTs), quasi-RCTs, observational studies, open-label studies, and retrospective studies were included. Case series and case reports were excluded. All descriptions and data were extracted independently by two authors.ResultsSeven studies evaluating gabapentin with a total of 179 patients were included. Most patients were refractory to antihistamines and topical emollients. Statistically significant favorable outcomes on pruritus scores were found in six studies. Five studies evaluated antipruritic efficacy based on a 10-point visual analog scale (VAS), and improvements in the range of an absolute decrease of 5.7 to 9.4 points from baseline were achieved on average by 3–8 weeks of treatment. Side effects are common with six studies reporting at least 26 incidences of side effects such as somnolence, dizziness, and fatigue. A total of four patients reportedly discontinued gabapentin due to intolerability.LimitationsOur review is limited by the inclusion of generally small, lower quality studies that lacked comparator groups or were open-label studies. Since the first two randomized controlled trials were published, no further high-quality studies have been conducted.ImplicationsOur review supports a trial of gabapentin for the management of UP in hemodialysis patients refractory to antihistamines and/or emollients. The results should be interpreted cautiously due to the lower quality of included studies. We recommend a starting dose of 100 mg orally after hemodialysis to minimize adverse events in this population.

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

“…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. ).…”

Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges

“…53,[96][97][98] In a double-blind, crossover, RCT of 25 HD patients assigned to gabapentin 300 mg by mouth after dialysis or placebo, pruritus intensity significantly improved with gabapentin but not with placebo. 53 Similarly, in a double-blind, placebo-controlled trial of 34 HD …”

“…98 A recent qualitative systematic review of 7 studies evaluating gabapentin (179 participants) supported a trial of gabapentin for the treatment of CKD-aP refractory to antihistamines and/or emollients. 97 Pregabalin, a medication similar to gabapentin, may also improve CKD-aP 37,99 and may be particularly useful when patients are not able to tolerate gabapentin. 1,100 In a randomized, crossover trial, 50 HD patients were assigned to gabapentin 300 mg or pregabalin 75 mg daily.…”

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

“…Four randomized, controlled trials of a total of 138 patients with severe pruritus have shown gabapentin to reduce itch by between 4.6 and 6.4 cm more than placebo on a 10-cm visual analog scale (8,9) (Supplemental Movie 2). Pregabalin (n=67) reduced itch severity by 4.6 cm more than placebo (n=57) and also improved sleep quality and health-related quality of life (10).…”