Interventions for itch in people with advanced chronic kidney disease

Hercz, Daniel; Jiang, Simon; Kapoor, Tanvir; Webster, Angela C

doi:10.1002/14651858.cd011393

Cited by 16 publications

(35 citation statements)

References 31 publications

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“…A randomised single-blind clinical trial comparing pregabalin (50 mg every other day) versus doxepin (10 mg daily) showed pregabalin to be more effective than doxepin in reducing the severity of CKD-aP and improving the quality of life of patients [58]. A 12-week randomized, double-blind, placebo-controlled study that included 179 HD patients compared pregabalin (75 mg twice per week) versus ondansetron (8 mg daily) or placebo, showed pregabalin to be superior [59], which is consistent with meta-analysis of 3 randomised studies showing ondansetron to be equivalent to placebo in the treatment of CKD-aP [55].…”

Section: Managementmentioning

confidence: 63%

“…Both gabapentinoids have been used in the management of CKD-aP. Multiple double-blind placebo-controlled trials have shown a statistically significant benefit of gabapentin compared to placebo in the management of CKD-aP and a recent meta-analysis found these agents to be effective (mean reduction in the itch score compared with placebo of 4.95, 95% confidence interval [CI] 4.44–5.46; based on 5 trials including 297 participants) and safe [55]. A starting dose of 100 mg gabapentin or 25 mg pregabalin in the evening is recommended to minimize adverse events in this population [56].…”

Section: Managementmentioning

confidence: 99%

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Chronic Kidney Disease-Associated Pruritus: A Review

Makar

Smyth

Brennan³

2021

Kidney Blood Press Res

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Background: Chronic kidney disease-associated pruritus (CKD-aP), also known as uraemic pruritus, is a disabling symptom for patients and a challenging condition for clinicians. Despite being common amongst end-stage kidney disease (ESKD) patients, it remains underestimated and underdiagnosed. The exact pathogenesis remains largely elusive, which hampers the synthesis of a definite treatment approach. Summary: Chronic pruritus (lasting 6 weeks or more in duration) is a common and potentially disabling symptom in patients with advanced CKD. A unified hypothesis of pathogenesis has not yet been concluded. Studies have shown changes in the immunochemical milieu of the skin in patients with CKD-aP with several inciting stimuli identified. However, other unrecognized factors are likely to be involved. This article will review the current observations and understanding of the postulated pathogenesis of CKD-aP, as well as the evidence for current management strategies. Key Messages: CKD-aP is a common and troubling symptom amongst ESKD patients that is associated with decreased quality of life and poor prognosis. Its exact pathogenesis, at the time of writing, is not well-understood. A stepwise approach is recommended for management. Systematic reviews show the largest body of evidence was found for the effectiveness of gabapentin. Comparison is needed between newly emerging pharmacological agents such as kappa-opioid receptor agonists and more established agents, such as the gabapentinoids. Finally, renal transplantation should be considered in severe and refractory cases who are suitable transplant candidates as it has shown an excellent outcome in most cases.

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Section: Managementmentioning

confidence: 63%

Section: Managementmentioning

confidence: 99%

Chronic Kidney Disease-Associated Pruritus: A Review

Makar

Smyth

Brennan³

2021

Kidney Blood Press Res

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“…. ) compared to UV-A/placebo" [309]. Based on our experiences with NB-UVB in adult CKD-aI patients and in children with various inflammatory dermatoses, we conclude that this modality can be cautiously used in children older than 4 years with CKD-aI not responding to topical therapy.…”

Section: Phototherapymentioning

confidence: 88%

“…Direct comparison between both drugs revealed no difference between their effectiveness [327,328,332], although gabapentin may be switched to pregabalin in case of insufficient tolerance. As mentioned in Cochrane systematic review on CKD-aI, GABA analogues have been studied in the highest number of RCT and both demonstrated the greatest effect size versus their comparators [309]. Importantly, the authors also emphasized that gabapentin is rarely mentioned as the first line of therapy in different guidelines on CKD-aI, while the most common practice still involves H 1 -antihistamines.…”

Section: Gabapentinoidsmentioning

confidence: 99%

Chronic Kidney Disease-Associated Itch (CKD-aI) in Children—A Narrative Review

Reszke

Kiliś‐Pstrusińska

Szepietowski

2021

Toxins

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Chronic kidney disease (CKD) is a condition of widespread epidemiology and serious consequences affecting all organs of the organism and associated with significant mortality. The knowledge on CKD is rapidly evolving, especially concerning adults. Recently, more data is also appearing regarding CKD in children. Chronic itch (CI) is a common symptom appearing due to various underlying dermatological and systemic conditions. CI may also appear in association with CKD and is termed chronic kidney disease-associated itch (CKD-aI). CKD-aI is relatively well-described in the literature concerning adults, yet it also affects children. Unfortunately, the data on paediatric CKD-aI is particularly scarce. This narrative review aims to describe various aspects of CKD-aI with an emphasis on children, based on the available data in this population and the data extrapolated from adults. Its pathogenesis is described in details, focusing on the growing role of uraemic toxins (UTs), as well as immune dysfunction, altered opioid transmission, infectious agents, xerosis, neuropathy and dialysis-associated aspects. Moreover, epidemiological and clinical aspects are reviewed based on the few data on CKD-aI in children, whereas treatment recommendations are proposed as well, based on the literature on CKD-aI in adults and own experience in managing CI in children.

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“…We retrieved the full texts of the remaining 16 articles. After assessing for eligibility, we excluded 12 articles because five were review articles [17][18][19][20][21], one was non-RCT [22], two were not focused on UP [23,24], two were conducted on patients undergoing different treatment interventions [25,26], one was a conference abstract [27], and one was a retrospective study [16]. Finally, four RCTs fulfilled the selection criteria and were included in the meta-analysis [28][29][30][31].…”

Section: Study Characteristicsmentioning

confidence: 99%

Clinical Efficacy and Safety of Sodium Thiosulfate in the Treatment of Uremic Pruritus: A Meta-Analysis of Randomized Controlled Trials

Chuo

Kuo

et al. 2021

Toxins

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Uremic pruritus is a distressful complication of chronic kidney disease and results in impaired quality of life and higher mortality rates. Intravenous sodium thiosulfate has been reported to alleviate pruritus in hemodialysis patients. We performed a systematic review and meta-analysis to estimate the efficacy of intravenous sodium thiosulfate in patients with uremic pruritus. A systematic search of electronic databases up to June 2021 was conducted for randomized controlled trials that evaluated the clinical effects of sodium thiosulfate in the management of patients with uremic pruritus. Two reviewers selected eligible articles and evaluated the risk of bias; the results of pruritus assessment and uremic pruritus-related laboratory parameters in selected studies were analyzed. There are four trials published between 2018 and 2021, which include 222 participants. The sodium thiosulfate group displayed significant decrease in the pruritus score (standardized mean difference = −3.52, 95% confidence interval = −5.63 to −1.41, p = 0.001), without a significant increase in the adverse effects (risk ratio = 2.44, 95% confidence interval = 0.37 to 15.99, p = 0.35) compared to the control group. Administration of sodium thiosulfate is found to be a safe and efficacious complementary therapy in improving uremic pruritus in patients with chronic kidney disease.

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Interventions for itch in people with advanced chronic kidney disease

Cited by 16 publications

References 31 publications

Chronic Kidney Disease-Associated Pruritus: A Review

Chronic Kidney Disease-Associated Pruritus: A Review

Chronic Kidney Disease-Associated Itch (CKD-aI) in Children—A Narrative Review

Clinical Efficacy and Safety of Sodium Thiosulfate in the Treatment of Uremic Pruritus: A Meta-Analysis of Randomized Controlled Trials

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