Histamine and Serotonin in Uremic Pruritus: Effect of Ondansetron in CAPD-Pruritic Patients

Abstract

Pruritus is a common, unpleasant symptom of uremic patients. Serotonin and histamine have been reported as possible mediators of uremic pruritus, and ondansetron is a potent and selective inhibitor of 5-HT₃ receptors. The aims of our study were (1) to evaluate the effect of ondansetron on uremic pruritus in continuous ambulatory peritoneal dialysis (CAPD) patients and its safety and (2) to investigate the role of histamine and serotonin in uremic pruritus. To study the prevalence and pathogenesis of uremic pruritus, CAPD and hemodialysis (HD) patients were asked to complete a pruritus questionnaire. The replies were scored based on numerical scales, and the results were evaluated by the same investigator who did not know the patients. Pruritus was graded, according to the total points for each patient, as mild, moderate, or severe. Of 54 patients on HD, 29 (53.7%) had pruritus, and of 43 patients on CAPD, pruritus was present in 21 (48.8%). In HD patients, pruritus was mild in 14 (48.3%), moderate in 12 (41.4%), and severe in 3 (10.3%) patients; the distribution in CAPD patients was 9 (42.9%), 10 (47.6%), and 2 (9.5%), respectively. There was no correlation between the presence and severity of pruritus and age, sex, primary renal disease, duration of dialysis, dialysis solutions used, and hematological and biochemical parameters except for serum histamine and serotonin levels and their product. Plasma histamine levels in CAPD patients were 13.1 ± 1.1 ng/ml in pruritic and 11.0 ± 3.9 ng/ml in nonpruritic patients (p = 0.06), serum serotonin levels were 115.6 ± 43.3 ng/ml and 64 ± 42.3 ng/ml (p < 0.05), respectively, and the histamine × serotonin product was 1,461 ± 576 and 646 ± 545 (p < 0.01), respectively. Eleven CAPD patients (6 males, 5 females) with a mean age of 66 (range 33–83) years and an average time on CAPD of 18 (range 3–31) months with moderate to severe pruritus were treated with ondansetron (4 mg twice daily p.o.) for a mean period of 3 (range 1–5) months. All patients responded to the treatment. There was a significant reduction of the severity of pruritus from the start of treatment, and on the 3rd day the pruritic score (mean value) was 10 (range 5–19) points, while at time 0 (before treatment) it was 26 (range 19–37) points (p < 0.0001). Pruritus disappeared in 7 patients at the end of the 1st week and in all patients at the end of the 2nd week of treatment. This effect was maintained during the study. Plasma histamine levels decreased significantly during the treatment from 12.9 ± 1.2 to 6.7 ± 5.9 ng/ml (p < 0.05). Also, serum serotonin levels were reduced from 125.1 ± 47.8 to 59.3 ± 27.5 ng/ml (p < 0.05) at the end of the 1st month of treatment, and the histamine × serotonin product showed a more significant reduction: from 1,544 ± 656 to 454 ± 436 (p < 0.01). Three patients reported an improvement in their nausea and vomiting during the treatment. Weekly clinical and laboratory examinations showed no side effects, adverse reactions, or other complications. Our data indicate that o...

5-Hydroxytryptamine (5-HT)2Receptor Involvement in Acute 5-HT-Evoked Scratching but Not in Allergic Pruritus Induced by Dinitrofluorobenzene in Rats

“…One goal of the present study was therefore to investigate which 5-HT receptor subtypes are involved in acute scratching elicited by intradermal 5-HT in the rat. Although 5-HT 3 receptors have been implicated in itch associated with cholestasis, uremia, and spinal opioids (Schworer et al, 1995;Balaskas et al, 1998;Kyriakides et al, 1999), 5-HT 3 receptor antagonists did not affect scratching elicited by intradermal 5-HT in mice, in contrast to the blockade of scratching by 5-HT 2 antagonists (Yamaguchi et al, 1999). These data argue against a role for 5-HT 3 receptors in acute evoked scratching in mice.…”

Ondansetron Treatment in a Child Presenting with Chronic Intractable Pruritus

“…Ondansetron has been shown to be effective for the treatment of certain cases of uremic pruritus (6,14), but this finding has been refuted by another study (15). Some studies showed that neuraxial opioid-induced pruritus respond to prophylaxis (3,16,17) and treatment (5,18) with ondansetron.…”

“…Le prurit n'a pas répondu à un traitement classique aux antipruritiques, mais a répondu à l'ondansétron, un antagoniste sélectif des récepteurs 5-hydroxytryptamine de type 3. O ndansetron is effective against chemotherapy-induced and postoperative nausea and vomiting (1,2). Over the past few years, several publications reported on the efficacy of ondansetron in treating neuraxial opioid-induced pruritus (3)(4)(5) and uremic pruritus in continuous ambulatory peritoneal dialysis (6). The current report presents a case of a child suffering from chronic pruritus refractory to conventional antipruritic drugs who was successfully treated with ondansetron.…”

Uremic pruritus – a review

“…Serotonin levels were also increased in CKD associated pruritus. Serotonin may cause itching by stimulating a 5-HT 3 receptor ondansetron and granisetron which have shown conflicting results regarding their effectiveness in relieving itch in patients [19][20][21].…”