Interventions for itch in people with advanced chronic kidney disease

Efficacy of Difelikefalin for the Treatment of Moderate to Severe Pruritus in Hemodialysis Patients: Pooled Analysis of KALM-1 and KALM-2 Phase 3 Studies

“…In a Cochrane review of interventions for itch in patients with advanced CKD, the authors concluded that gabapentinoids were the most studied therapeutics for the treatment of CKD-aP and show the greatest reductions in itch scores. 7 , 8 It is important to consider that gabapentinoids are not approved anywhere in the world for the treatment of pruritus in patients treated by HD, and the safety and efficacy in this population have not been evaluated in a rigorous clinical development program. In addition, there are varying recommendations for dosing and limitations with respect to the tolerability of gabapentinoids that must be considered in this population.…”

“… 1 , 7 Off-label treatments may include antihistamines, topical corticosteroids, and gabapentin or pregabalin; although there are reports that treatments like gabapentin and pregabalin are effective at reducing itch, their side effects sometimes prevent their use in this patient population. 7 , 8 No treatments have been approved for CKD-aP in Europe and only 1 treatment, the centrally acting mixed μ-opioid receptor partial agonist and κ-opioid receptor agonist nalfurafine, has been approved in Japan (2009) and South Korea (2013). 3 , 9 , 10 , 11 A variety of other therapeutics with novel mechanisms of action are being evaluated, but well-controlled clinical studies are still needed to evaluate the efficacy and safety of these therapies for patients with CKD-aP.…”

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

“…Among secondary outcomes, NB-UVB provided significant improvement only in the body surface area affected by itch ( p = 0.006). In a recent Cochrane systematic review on the management of CKD-aI the authors stated that “ UVB radiation may make little or no difference to uraemic itch (…) 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.…”

“…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.…”

Utility of a Single Itch-Related Question and the Skindex-10 Questionnaire for Assessing Pruritus and Predicting Health-Related Quality of Life in Patients Receiving Hemodialysis

“… 1 , 5 Although treatment is not well established in guidelines, an observational study reported that gabapentin or pregabalin relieved itching in 85% of 71 consecutively treated patients with CKD. 11 , 12 , 13 Nonetheless, patients are most often prescribed an antihistamine or corticosteroid rather than gabapentin or other agents shown to have an antipruritic action (eg, nalfurafine; only approved in Japan and South Korea).…”