Gabapentin: A promising therapy for uremic pruritus in hemodialysis patients: A randomized-controlled trial and review of literature

Abstract

Background: Treatment of uremic pruritus (UP) is a big challenge. Objectives: To evaluate efficacy, appropriate dosing regimen and safety of gabapentin on UP in hemodialysis (HD) patients. Patients and methods: Fifty-four uremic patients undergoing HD and complaining of UP were randomly classified into two equal groups. Gabapentin group: 27 patients received gabapentin capsules starting with 100 mg and gradually titrated up to a maximum of 300 mg after each HD session for one month. Placebo group: 27 patients received placebo thrice weekly after each HD session. Severity of pruritus was measured by visual analog scale (VAS) and 5-D pruritus scale. Results: In gabapentin group, 88.9% of patients responded well to gabapentin versus 22.2% in placebo group. A highly statistical difference was detected in favor of gabapentin group (p< 0.001). The frequency of the use of the lowest dose (100 mg thrice weekly) was significantly higher than other doses (p < 0.0001). Adverse effects were mild and tolerated. Conclusion: Gabapentin is a promising and a well-tolerated treatment option for patients with UP. We recommend it as a first line therapy with a maintenance post-HD dose of 100–300 mg. We also recommend the 5-D scale in the assessment of the severity of pruritus.

Keywords:

• Uremic pruritus
• gabapentin
• hemodialysis
• VAS
• 5-D pruritus scale

Acknowledgements

We thank all colleagues in the hemodialysis unit of Zagazig University Hospitals for their continuous help and kindness. We also thank all subjects who agreed to participate in this study.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.