Background:Patients undergoing hemodialysis or peritoneal dialysis often experience pruritus which is associated with morbidity and mortality. One proposed treatment approach is to target the opioid pathway using either µ-opioid antagonists or κ-opioid agonists.Objective:To review the efficacy of targeting the opioid pathway for pruritus among dialysis patients (uremic pruritus).Design:Systematic review and meta-analysis.Setting/Methods:The systematic review included randomized controlled and randomized crossover trials identified in the MEDLINE, EMBASE, and Cochrane databases (1990 to June 2014) evaluating the efficacy of µ-opioid antagonists or κ-opioid agonists in the treatment of uremic pruritus.Patients:Adult (≥18 years) chronic dialysis patients.Measurements:The primary outcome being evaluated was reduction in itch severity measured on a patient-reported visual analog scale (VAS).Results:Five studies out of 3587 screened articles met the inclusion criteria. Three studies evaluated the efficacy of naltrexone, a µ-opioid antagonist, and 2 studies evaluated the efficacy of nalfurafine, a κ-opioid agonist. Duration of included studies was short, ranging from 2 to 9 weeks.Limitations:Due to the heterogeneity in reporting of outcomes, data from the studies evaluating naltrexone could not be pooled. Pooled analysis, using a random effects model, found that use of nalfurafine resulted in a 9.50 mm (95% confidence interval [CI], 6.27-12.74, P < .001) greater reduction of itch severity (measured on a 100-mm VAS) than placebo in the treatment of uremic pruritus.Conclusions:Nalfurafine holds some promise with respect to the treatment of uremic pruritus among dialysis patients. However, more long-term randomized controlled trials evaluating the efficacy of therapies targeting the opioid pathway for uremic pruritus are required.

Participatory action projects, such as Photovoice, can provide medical trainees with a unique opportunity for community engagement. Through Photovoice, participants with lived experience engage in dialog and capture photographs of community issues. Participants subsequently develop narratives that accompany photos to raise awareness about community needs. In this paper, we describe twelve tips to develop a Photovoice project and discuss how medical students can engage communities through a participatory action lens. Such an approach not only serves as a method for medical students to learn about social determinants of health through the perspective of lived experience, but also has the capacity of building advocacy and community collaboration skills. Through providing a voice to marginalized individuals using Photovoice, medical students can partner with communities to work toward social change. Photovoice participants also benefit from the project as it provides them with a platform to highlight strengths and weaknesses in their community.

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