Uremic pruritus is improved by gabapentin

Current and emerging systemic treatments targeting the neural system for chronic pruritus

INTRODUCTION

Pruritus is a debilitating symptom that significantly affects the quality of life of patients who suffer from it. Many current and emerging systemic treatments targeting the neural system have been successful in treating itch of various underlying etiologies.

AREAS COVERED

A complete search of the PUBMED and Google Scholar databases was completed and literature pertinent to current and emerging systemic anti-pruritic drugs which target the neural system was compiled. The purpose of this review is to give the reader with an overview of the current and emerging systemic therapeutic options which target the neural system for chronic pruritus. The authors then provide the reader with their expert perspectives on the future of these therapies.

EXPERT OPINION

Exciting new anti-pruritic therapies targeting the neural system which show promise include NK-1 inhibitors, opioid receptor modulators, and drugs targeting specific itch receptors such as Mrgpr, Na_v1.7, and PAR2, as well as selective GABA modulators. Future studies should be conducted in order to fully understand these exciting therapeutic options.

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

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.

Chinese herbal bath therapy for the treatment of uremic pruritus: meta-analysis of randomized controlled trials

Background

Chinese herbal bath therapy (CHBT) is a traditional external therapy that has been used for the treatment of uremic pruritus (UP) in China. We conducted a meta-analysis to evaluate the efficacy and safety of CHBT for UP.

Methods

We searched seven databases for studies published since database inception to September 1, 2018. Randomized trials evaluating CHBT for UP were collected. The therapeutic effects of CHBT were measured by the pruritus level (via the visual analogue scale (VAS) or the symptom score scale) and the total effective rate. We combined studies using mean difference (MD) for continuous outcomes and using risk ratio for dichotomous data, both with 95% confidence intervals. RevMan V.5.3 software was used to assess the data reported and perform the meta-analysis.

Results

Seventeen articles including 970 patients were identified. All participants were haemodialysis (HD) patients. CHBT is administered by immersing the whole body in a prepared herbal water bath. On average, an herbal bath prescription included 11 Chinese herbs. The mean treatment duration was 4.7 weeks. Compared with basic treatment (HD or haemoperfusion (HP)) and adding a control of sham CHBT, clear hot water bath, or calamine lotion, CHBT plus basic treatment reduced the VAS score (MD = − 2.38; 95% confidence intervals [CI], − 3.02 to − 1.74; P < 0.00001) and the symptom score (MD = − 8.42; 95% confidence intervals [CI], − 12.47 to − 4.36; P < 0.00001) and had a higher total effectiveness rate (risk ratio [RR] = 1.46; 95% CI, 1.31 to 1.63; P < 0.00001).

Conclusions

In conclusion, CHBT could be a complementary therapy for improving pruritic symptoms in uraemia patients. More rigorously designed, multicentre, prospective RCTs are warranted to further identify the efficacy and safety of CHBT.

Trial registration

Systematic review registration: [PROSPERO registration: CRD42018108506].

Electronic supplementary material

The online version of this article (10.1186/s12906-019-2513-9) contains supplementary material, which is available to authorized users.

Prevalence and Associated Factors of Uraemic Pruritus in Continuous Ambulatory Peritoneal Dialysis Patients

OBJECTIVE

Uraemic pruritus is a distressing symptom that has a negative impact on the quality of life for dialysis patients. The pathophysiology of pruritus in peritoneal dialysis (PD) patients is still poorly understood. The present study aims to investigate the prevalence and related risk factors of pruritus in continuous ambulatory peritoneal dialysis (CAPD) patients.

METHODS

In total, 362 CAPD cases were investigated from January 2012 to April 2013. Pruritus was assessed by visual analogue scale.

RESULTS

The prevalence of severe pruritus and mild to moderate pruritus was 12.7% and 52.5%, respectively. The patients with severe pruritus had the longest duration of PD (p<0.001), Pittsburgh Sleep Quality Index (PSQI) score (p<0.001), Beck Depression Inventory (BDI) score (p=0.003), intact parathyroid hormone (iPTH) level (p=0.009), and the lowest Medical Outcomes Short Form 36 Health Survey, Physical Component Score (SF-36 PCS) (p<0.001) among the three groups. The patients with mild to moderate pruritus had a significantly higher iPTH level (p=0.004) compared with the patients without pruritus. A multivariate logistic regression for pruritus showed that higher PSQI score [odds ratio (OR)=1.305, p=0.001], higher BDI score (OR=1.429, p=0.002), longer vintage (OR=1.039, p=0.004), and higher iPTH level (OR=1.317, p=0.014) were independently associated with pruritus.

CONCLUSION

The prevalence of uraemic pruritus was 65.2% in CAPD patients. Sleep disorder, depression, longer vintage, and a higher iPTH level were independent associated factors for pruritus in CAPD patients.