Pharmacologic Treatment of Common Symptoms in Dialysis Patients: A Narrative Review.
End-stage renal disease (ESRD) patients receiving hemodialysis experience a heavy burden of disease-related symptoms, which lead to reduced quality of life. This review focuses on aspects of ESRD-related pharmacokinetics and on efficacy of drugs for treatment of somatic symptoms. Fatigue, pruritus, insomnia, and cramps are the most common symptoms in ESRD, and studies suggest that they are often undertreated. However, few evidence-based guidelines exist to guide therapy in patients received dialysis. In the context of this review, we examine the role of l-Carnitine in the treatment of fatigue and cramps; human growth hormone analog Norditropin and anabolic steroid Nandrolone for the treatment of fatigue; Gabapentin and other agents for the management of pruritis; Vitamin and creatine supplementation in the management of dialysis-associated cramps, and somnambulates in the treatment of dialysis-related insomnia. Treatment decisions should be made in consultation with patients with a full accounting of the potential risks and benefits of these therapies.
Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut.|Section of Nephrology, West Haven VA Medical Center, West Haven, Connecticut.
Dennis G
DG
Moledina
Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut.|Yale Program of Applied Translational Research, New Haven, Connecticut.
Francis
F
Perry Wilson
D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D009120:Muscle Cramp / Q000188:drug therapy* / Q000209:etiology*; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology*; D006435:Renal Dialysis