For Treating Uremic Pruritus, Evidence is Strongest for Gabapentin

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Except for gabapentin, evidence for 38 other treatments is weak and limited by small studies with a high risk of bias, new review finds.
Except for gabapentin, evidence for 38 other treatments is weak and limited by small studies with a high risk of bias, new review finds.

Gabapentin is the only treatment for uremic pruritus in patients with advanced chronic kidney disease (CKD) with strong supportive evidence of effectiveness, according to a systematic review. Evidence for other treatments “is weak and limited by small studies with a high risk of bias,” a team led by Claudio Rigatto, MD, MSc, of the University of Manitoba in Winnepeg, Canada, reported online ahead of print in the American Journal of Kidney Diseases.

Dr Rigatto and his colleagues reviewed 44 randomized controlled trials involving patients with advanced CKD (stage 3 or higher) or receiving any form of dialysis. The trials examined 39 different uremic pruritus treatments, including gabapentin, pregabailin, mast cell stabilizers, phototherapy, hemodialysis modifications, and other systemic therapies (such as naltrexone, primrose oil, and thalidomide) and topical therapies (such as capsaisin cream and Dead Sea mineral lotion).

“The main finding of our comprehensive systematic review of treatments for uremic pruritus is that with the exception of the evidence for gabapentin, there remains considerable uncertainty about effective treatments for this important and burdensome symptom in patients with kidney failure,” the researchers wrote.

The authors cited studies showing that uremic pruritus affects up to 46% of patients on hemodialysis.

Reference

Simonsen E, Komenda P, Lerner B, et al. Treatment uremic pruritus: A systematic review. Am J Kidney Dis 2017; published online ahead of print.

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