title: Uraemic pruritus: relief of itching by gabapentin and pregabalin.
abstract: BACKGROUND
  Pruritus (skin irritation or itching) is common in patients with chronic kidney disease (CKD) stages 4 and 5. It is associated with disrupted sleep, reduced quality of life, depression and increased mortality. A video of a patient describing the symptoms is at vimeo.com/49458473.
  
  
  METHODS
  We used gabapentin or pregabalin in 71 consecutive patients, 82% male. 25 had CKD stage 4 or 5, median eGFR = 17, range 9-30; 40 were on haemodialysis; 6 on peritoneal dialysis. Median itch severity score out of 10 = 8, range 6-10; median duration of itching = 6 months, range 0.5-240. Serum calcium ≤2.60 mmol/l (≤10.4 mg/dl) in 87% patients, phosphate ≤1.8 mmol/l (≤5.6 mg/dl) in 75%. 63% had used antihistamines and not gained relief. Starting dose of gabapentin 100 mg after dialysis or daily. Patients intolerant of gabapentin were offered pregabalin, starting dose 25 mg after dialysis or daily.
  
  
  RESULTS
  Gabapentin relieved itching in 47 patients (66%). A video of a patient describing the effect is at vimeo.com/49455976. 26 patients (37%) suffered side effects from gabapentin. Of 21 patients who stopped gabapentin due to side effects, 16 started pregabalin. Pregabalin relieved itching in 13 patients (81%). In total, gabapentin or pregabalin relieved itching in 60 patients (85%), median follow-up 2 months (range 1-8 months). Median itch severity out of 10 reduced from 8 to 1.
  
  
  CONCLUSIONS
  Gabapentin or pregabalin relieved itching in 85% of 71 consecutively treated CKD patients. Patients should be advised about side effects and the drug initiated at a low dose. Patients intolerant of gabapentin may tolerate pregabalin.
authors.affiliation: Heart of England NHS Foundation Trust, Birmingham, UK. hugh.rayner@heartofengland.nhs.uk
authors.forename: Hugh
authors.initials: H
authors.lastname: Rayner
authors.forename: Jyoti
authors.initials: J
authors.lastname: Baharani
authors.forename: Steve
authors.initials: S
authors.lastname: Smith
authors.forename: Vijayan
authors.initials: V
authors.lastname: Suresh
authors.forename: Indranil
authors.initials: I
authors.lastname: Dasgupta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000588:Amines / Q000008:administration & dosage*; D000700:Analgesics / Q000008:administration & dosage; D015897:Comorbidity; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069583:Pregabalin; D015995:Prevalence; D011537:Pruritus / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014511:Uremia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin