Efficacy and Safety of Gabapentin for Uremic Pruritus and Restless Legs Syndrome in Conservatively Managed Patients With Chronic Kidney Disease

Hassan, Hicham I. Cheikh; Brennan, Frank; Collett, Gemma; Josland, Elizabeth; Brown, Mark

doi:10.1016/j.jpainsymman.2014.08.010

Cited by 35 publications

(25 citation statements)

References 23 publications

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“…51 In the comparison group of patients on dialysis, gabapentin was found to be similarly effective at a similar average dose; however, the rate of side effects in the dialysis group was significantly lower at only 14%, although the rate of drug discontinuation was not statistically different. 51 Gunal et al 52 enrolled 25 patients on HD in a randomized, placebo-controlled, double-blind trial of gabapentin at 300 mg three times per week for 4 weeks after dialysis and reported a significant response, namely a decrease in mean VAS score from 7.9 to 1.2, with no participants needing to drop out because of secondary side effects. Other small-scale studies have shown similar improvement in pruritus with doses of 100 or 300 mg of gabapentin after hemodialysis.…”

Section: Treatmentmentioning

confidence: 83%

“…Recently, Cheikh Hassan et al 51 published their results from a single-center retrospective cohort study testing the safety and efficacy of gabapentin for the treatment of restless legs syndrome and pruritus in patients with renal disease ranging from stage 3 CKD to ESRD. They specifically assessed gabapentin use in a group of 34 patients managed conservatively (ie, without dialysis) and compared the results with results from a group of 15 patients on dialysis.…”

Section: Treatmentmentioning

confidence: 99%

“…They specifically assessed gabapentin use in a group of 34 patients managed conservatively (ie, without dialysis) and compared the results with results from a group of 15 patients on dialysis. 51 In the conservatively managed patients they found that gabapentin successfully reduced pruritus with a median daily dose of 100 mg, but 47% of patients experienced one or more side effects, leading to a 17% rate of permanent treatment discontinuation. 51 In the comparison group of patients on dialysis, gabapentin was found to be similarly effective at a similar average dose; however, the rate of side effects in the dialysis group was significantly lower at only 14%, although the rate of drug discontinuation was not statistically different.…”

Section: Treatmentmentioning

confidence: 99%

“…51 In the conservatively managed patients they found that gabapentin successfully reduced pruritus with a median daily dose of 100 mg, but 47% of patients experienced one or more side effects, leading to a 17% rate of permanent treatment discontinuation. 51 In the comparison group of patients on dialysis, gabapentin was found to be similarly effective at a similar average dose; however, the rate of side effects in the dialysis group was significantly lower at only 14%, although the rate of drug discontinuation was not statistically different. 51 Gunal et al 52 enrolled 25 patients on HD in a randomized, placebo-controlled, double-blind trial of gabapentin at 300 mg three times per week for 4 weeks after dialysis and reported a significant response, namely a decrease in mean VAS score from 7.9 to 1.2, with no participants needing to drop out because of secondary side effects.…”

Section: Treatmentmentioning

confidence: 99%

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Pruritus in Kidney Disease

Combs

Teixeira

Germain

2015

Seminars in Nephrology

134

106

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Summary Pruritus is a common and distressing symptom in patients with chronic kidney disease. The most recent epidemiologic data have suggested that approximately 40% of patients with end-stage renal disease experience moderate to severe pruritus and that uremic pruritus (UP) has a major clinical impact, being associated strongly with poor quality of life, impaired sleep, depression, and increased mortality. The pathogenesis of UP remains largely unclear, although several theories on etiologic or contributing factors have been proposed including increased systemic inflammation; abnormal serum parathyroid hormone, calcium, and phosphorus levels; an imbalance in opiate receptors; and a neuropathic process. UP can present somewhat variably, although it tends to affect large, discontinuous, but symmetric, areas of skin and to be most symptomatic at night. A variety of alternative systemic or dermatologic conditions should be considered, especially in patients with asymmetric pruritus or other atypical features. Treatment initially should focus on aggressive skin hydration, patient education on minimizing scratching, and optimization of the aspects of chronic kidney disease care that are most relevant to pruritus, including dialysis adequacy and serum parathyroid hormone, calcium, and phosphorus management. Data for therapy specifically for UP remain limited, although topical therapies, gabapentin, type B ultraviolet light phototherapy, acupuncture, and opioid-receptor modulators all may play a role.

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Section: Treatmentmentioning

confidence: 83%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Pruritus in Kidney Disease

Combs

Teixeira

Germain

2015

Seminars in Nephrology

134

106

View full text Add to dashboard Cite

show abstract

“…Cheikh Hassan et al studied the effect of gabapentin on relieving pruritus in dialysis patients (22). However, its use in dialysis patients requires accurate dose adjustments, and various studies have shown that neurotoxicity and coma occur in the absence of precise gabapentin dosing (23,24).…”

Section: Discussionmentioning

confidence: 99%

The Effects of Cool Dialysate on Pruritus Status During Hemodialysis of Patients With Chronic Renal Failure: A Controlled Randomized Clinical Trial

Rad

Jaghouri

Sharifipour

et al. 2016

Iran Red Crescent Med J

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Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis

et al. 2022

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IMPORTANCE An understanding of the long-term outcomes of patients with advanced chronic kidney disease not treated with maintenance dialysis is needed to improve shared decision-making and care practices for this population. OBJECTIVE To evaluate survival, use of health care resources, changes in quality of life, and end-oflife care of patients with advanced kidney disease who forgo dialysis.EVIDENCE REVIEW MEDLINE, Embase (Excerpta Medica Database), and CINAHL (Cumulative Index of Nursing and Allied Health Literature) were searched from inception through December 3, 2021, for all English language longitudinal studies of adults in whom there was an explicit decision not to pursue maintenance dialysis. Two investigators independently reviewed all studies and selected those reporting survival, use of health care resources, changes in quality of life, or end-of-life care during follow-up. Studies of patients who initiated and then discontinued maintenance dialysis and patients in whom it was not clear that there was an explicit decision to forgo dialysis were excluded.One author abstracted all study data, of which 12% was independently adjudicated by a second author (<1% error rate). FINDINGS Forty-one cohort studies comprising 5102 patients (range, 11-812 patients) were included in this systematic review (5%-99% men; mean age range, 60-87 years). Substantial heterogeneity in study designs and measures used to report outcomes limited comparability across studies. Median survival of cohorts ranged from 1 to 41 months as measured from a baseline mean estimated glomerular filtration rate ranging from 7 to 19 mL/min/1.73 m 2 . Patients generally experienced 1 to 2 hospital admissions, 6 to 16 in-hospital days, 7 to 8 clinic visits, and 2 emergency department visits per person-year. During an observation period of 8 to 24 months, mental well-being improved, and physical well-being and overall quality of life were largely stable until late in the illness course. Among patients who died during follow-up, 20% to 76% had enrolled in hospice, 27% to 68% died in a hospital setting and 12% to 71% died at home; 57% to 76% were hospitalized, and 4% to 47% received an invasive procedure during the final month of life. CONCLUSIONS AND RELEVANCEMany patients who do not pursue dialysis survived several years and experienced sustained quality of life until late in the illness course. Nonetheless, use of acute care services was common and intensity of end-of-life care highly variable across cohorts. These findings suggest that consistent approaches to the study of conservative kidney management are needed to enhance the generalizability of findings and develop models of care that optimize outcomes among conservatively managed patients.

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Efficacy and Safety of Gabapentin for Uremic Pruritus and Restless Legs Syndrome in Conservatively Managed Patients With Chronic Kidney Disease

Abstract: Gabapentin is a viable treatment for conservatively managed CKD and ESKD patients with pruritus and/or RLS, but side effects are common. Gabapentin should be used with caution although higher doses do not appear to be a factor associated with side effects.

Cited by 35 publications

References 23 publications

Pruritus in Kidney Disease

Pruritus in Kidney Disease

The Effects of Cool Dialysate on Pruritus Status During Hemodialysis of Patients With Chronic Renal Failure: A Controlled Randomized Clinical Trial

Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis

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