Uremic pruritus in hemodialysis patients: treatment with desloratidine versus gabapentin

Márquez, Diego; Ramonda, C. Paulina; Lauxmann, Jorge; Romero, César A; Vukelic, Valeria; Martinatto, Carolina; Barrón, Belén; Novoa, P.; Peixoto, Aldo J.; Orías, Marcelo

doi:10.1590/s0101-28002012000200007

Cited by 37 publications

(35 citation statements)

References 17 publications

(16 reference statements)

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“…The study showed that desloratadine presented significant improvement in itch, while gabapentin, although it also improved the symptom, was not statistically significant. 17 Furthermore, three of the six studies presented very similar methodologies, but one of the differences observed in these studies was the dosage of gabapentin 300 mg 3 times a week, 400 mg 2 times a week and 100 mg 3 times a week. 18-20 These three trials demonstrate the effectiveness of gabapentin over the placebo group.…”

Section: Resultsmentioning

confidence: 99%

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Psychotropics in different causes of itch: systematic review with controlled studies

Brasileiro

Barreto

Nunes

2016

An. Bras. Dermatol.

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Among the wide range of symptoms neglected or resistant to conventional treatments in clinical practice, itch is emerging gradually as a theme to be studied. Itch complaints and the negative effects in the quality of life are observed in several medical fields. Although the partially obscure pathophysiology, some researchers decided to check and test the use of psychotropic drugs in resistant itch to conventional topical treatments and antihistamines. The objective of this study was to evaluate scientific evidence in psychotropic use in the treatment of itch of various causes. This is a systematic review of scientific literature. The following databases were used: PubMed, Web of Science, Scopus and Scielo. Randomized controlled trials that should focus on treatment with psychotropic drugs of pruritus of various causes were the inclusion criteria. All articles were analyzed by the authors, and the consensus was reached in cases of disagreement. Fifteen articles were included after analysis and selection in databases, with the majority of clinical trials focusing on psychopharmacological treatment of itch on account of chronic kidney disease. Clinical trials with psychotropic drugs mostly indicated significant improvement in the itching. In most trials of chronic kidney disease as basal disease for itch, greater effectiveness was observed with the use of psychotropic drugs compared with placebo or other antipruritic. However, the small amount of controlled trials conducted precludes the generalization that psychiatric drugs are effective for itch of various causes.

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Section: Resultsmentioning

confidence: 99%

“…This occurred in the study of Marquez et al , in which four subjects discontinued the study due to gabapentin (fatigue and drowsiness) and one abandoned it when used desloratadine due to "nervousness". 17 In Razeghi et al , there was a loss caused by adverse events of gabapentin. 20 …”

Section: Resultsmentioning

confidence: 99%

Psychotropics in different causes of itch: systematic review with controlled studies

Brasileiro

Barreto

Nunes

2016

An. Bras. Dermatol.

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“…Low dose doxepin is safe and effective except for mild drowsiness. The drug is used at 10mg three times a day and relieved the symptoms in 43% of patients with CKD associated pruritus [52].…”

Section: Systemic Treatmentmentioning

confidence: 99%

Uremic pruritus – a review

Pvs¹,

Pk²,

Nethra³

et al. 2016

Glob Dermatol

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Uremic pruritus remains a frequent concern for hemodialysis patients with the most frustrating and disabling symptoms. The word uremic may denote that patients suffer from acute renal injury. Hence it is preferred to use the recent term "chronic kidney disease associated pruritus" (CKD-associated pruritus). The prevalence of CKD-associated pruritus in patients ranges from 15%-90% in various studies.Interestingly, in CKD associated pruritus the skin lesions are not found. The various skin lesions which range from excoriations, impetigo, linear crusts, papules and ulcers are secondary. Other co-existing diseases like cardiovascular diseases, diabetes, hypothyroidism, chronic liver or hematological diseases may challenge the diagnosis and management.The pathophysiology remains unexplained. There may be an imbalance between the antagonistic activities of µ-and] κ-opioid receptors. Itch sensation are correlated with the activation of certain areas in the brain, spatial and temporal aspects may be processed in the primary somatosensory cortex, planning of scratch response in the pre-motor and supplementary motor cortices, and affective and motivational aspects in the anterior cingulate cortex.

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“…Currently, investigators are evaluating the efficacy of agonists/antagonists of the opioid system 6,7 with gabapentin, pregabalin, and desloratadine, among others. [8][9][10][11][12][13][14] Despite the prevalence of pruritus in the ESRD population, its clinical effects are poorly described in the literature. Some studies indicate that skin itchiness has negative effects on quality of life beyond discomfort, including fatigue, poor sleep quality, and depression.…”

Section: Ramakrishnan Et Almentioning

confidence: 99%

Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms

Ramakrishnan¹,

Bond²,

Claxton³

et al. 2013

IJNRD

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Abstract:One of the most common conditions affecting end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) is pruritus. Studies report that itchy and dry skin, symptoms of pruritus, affect 40%-90% of ESRD patients. Yet, in clinical practice the condition is often underdiagnosed resulting in inadequate management and an underappreciated impact on patient outcomes. Two retrospective analyses were conducted: a preliminary analysis of ESRD patients with pruritus symptoms (n=73,124) undergoing HD or peritoneal dialysis at a large dialysis provider and a subsequent detailed analysis of a homogenous subset of patients undergoing in-center HD (n=38,315). The goal was to better understand the clinical burden of pruritus as it relates to patient characteristics, quality of life, medication use, and HD compliance. This population is commonly burdened by multiple comorbidities and related polypharmaceutical management; identifying the relationship of pruritus to these ailments can help guide future research and resource allocation. The detailed analysis confirmed trends observed in the preliminary analysis: 30% reported being "moderately" to "extremely bothered" by itchiness. The HD patient population with the highest severity of self-reported pruritus also had a consistent trend in overall increased resource utilization -higher monthly doses of erythropoietin-stimulating agents (53,397.1 to 63,405.4 units) and intravenous (IV) iron (237.2 to 247.6 units) and higher use of IV antibiotics (14.1% to 20.7%), as well as poorer quality-of-life measures (25-point reductions in Burden of Disease Score and Effects on Daily Life subscales of the Kidney Disease Quality of Life-36 survey). These results highlight the need to better identify and manage ESRD patients impacted by pruritus, as this symptom is associated with negative clinical outcomes and increased resource utilization. Further studies are needed to evaluate the current economic burden of pruritus in ESRD patients and create possible options for an improved pharmacoeconomic profile in this patient population.

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Uremic pruritus in hemodialysis patients: treatment with desloratidine versus gabapentin

Cited by 37 publications

References 17 publications

Psychotropics in different causes of itch: systematic review with controlled studies

Psychotropics in different causes of itch: systematic review with controlled studies

Uremic pruritus – a review

Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms

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