title: Efficacy and safety of gabapentin for uremic pruritus and restless legs syndrome in conservatively managed patients with chronic kidney disease.
abstract: BACKGROUND
  Pruritus and restless legs syndrome (RLS) frequently affect patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), impacting the quality of life. Gabapentin (1-aminomethyl cyclohexane acetic acid) alleviates these symptoms in hemodialysis (HD) patients, but data are lacking for patients on the conservative pathway.
  
  
  OBJECTIVE
  To determine the safety and effectiveness of gabapentin for pruritus or RLS in conservatively managed patients (n = 34) with CKD and ESKD.
  
  
  METHODS
  This was a single-center retrospective cohort study. We compared dosing and side effects in 34 CKD/ESKD patients with similar patients receiving HD (n = 15).
  
  
  RESULTS
  Forty-four percent of conservatively managed patients complained of RLS and/or pruritus; 18% were excluded for a nonuremic cause of symptom. Thirty-four patients were included in the final analysis. The most common starting daily dose of gabapentin was the equivalent of 50 mg (44.1%) or 100 mg (38.2%) daily, with the median daily dose of 100 mg (range 39-455 mg). Side effects occurred in 47% of patients, with 17% discontinuing gabapentin. Gabapentin reduced symptoms of pruritus (P < 0.001) and RLS (P < 0.05). There was no statistical difference when comparing HD and conservatively managed patients for daily starting dose (P = 0.88), median dose (P = 0.84), and final dose (P = 0.18). Patients conservatively managed were more likely to manifest side effects compared with HD patients (47.1% vs. 14.3%, P = 0.023). Dose was not found to be a factor associated with side effects in univariate analysis.
  
  
  CONCLUSIONS
  Gabapentin is a viable treatment for conservatively managed CKD and ESKD patients with pruritus and/or RLS, but side effects are common. Gabapentin should be used with caution although higher doses do not appear to be a factor associated with side effects.
authors.affiliation: Department of Renal Medicine, St. George Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Hicham I
authors.initials: HI
authors.lastname: Cheikh Hassan
authors.affiliation: Department of Renal Medicine, St. George Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia. Electronic address: fpbrennan@ozemail.com.au.
authors.forename: Frank
authors.initials: F
authors.lastname: Brennan
authors.affiliation: Department of Renal Medicine, St. George Hospital, Sydney, New South Wales, Australia.
authors.forename: Gemma
authors.initials: G
authors.lastname: Collett
authors.affiliation: Department of Renal Medicine, St. George Hospital, Sydney, New South Wales, Australia.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Josland
authors.affiliation: Department of Renal Medicine, St. George Hospital, Sydney, New South Wales, Australia.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Brown
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000588:Amines / Q000009:adverse effects / Q000627:therapeutic use*; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D003509:Cyclohexanecarboxylic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D011537:Pruritus / Q000188:drug therapy* / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D012148:Restless Legs Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D005680:gamma-Aminobutyric Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin
keywords: Gabapentin; conservative management; dialysis; end-stage kidney disease; pruritus; restless legs syndrome