Gabapentin therapy for pruritus in haemodialysis patients

Abstract EN

Background: Itch can be defined subjectively as a poorly localized, non-adapting, usually unpleasant sensation which elicits a desire to scratch .

Although specialized nerve endings have been identified for a wide range of stimuli no specific receptor has been identified for itch and it is generally agreed that itch (and pain) are received by unspecialized free nerve endings located close to the dermo-epidermal junction.

Generalized severe pruritus occurs in about (30-50 %) of renal failure cases, its one of the dermatological diseases that is difficult to control.

Unfortunately, haemodialysis can initiate the symptom as well as improve it.

Up to 85% of patients on haemodialysis suffer from itching.

Many modalities of treatment are found for those patients, as topical emollients, phototherapy, antihistamine.

Aim of study: To assess the effectiveness and safety of gabapentin in treatment of pruritus induced by dialysis.

Method: This study was conducted in Merjan teaching hospital Haemodialysis unite .23 patients were included in this study (13 male and 10 female , age more than 18 years) .

Haemodialysis was performed twice times per week.

All patients had histories of pruritus of more than 6 weeks duration that does not respond to antihistamines and other topical treatments .

Any medication with presumed antipruritic effects was discontinued one week before the study.

The patients were asked to record the severity of their pruritus on a visual analogue scale twice weekly (at dialysis time).

The scale consisted of a 10 cm horizontal line marked from 0 (denoting no itch ) to 10 (denoting worst possible imaginable itch).

Patients were assigned to receive 4 weeks of gabapentine therapy followed by 4 weeks of placebo and there was a 2 weeks of washout period between the sequential treatment phases.

Gabapentine 100mg or placebo was administered orally twice weekly at the end of haemodialysis sessions.

Result: The mean pruritus score before the treatment was 8.43 ± 0.99 with a range from (7-10), after gabapentin therapy the score decreased to 1.26 ± 1 (range : 0-3 ; p-value < 0.0001) while after the end of the resting two weeks (interval period) the score increased to 7.56± 1.55 , increment continued to the end of placebo period (after one month) reached to 8.1 ± 1.01 (range : 6-10 ; p-value = 0.1686).

Conclusion: Gabapentin is a safe and effective drug in treatment of pruritus induced by dialysis with little side effects.