Pregabalin versus gabapentin in the treatment of neuropathic pruritus in maintenance haemodialysis patients: A prospective, crossover study

Yalcin Solak, Zeynep Biyik, Huseyin Atalay, Abduzhappar Gaipov, Figen Guney, Suleyman Turk, Adrian Covic, David Goldsmith, Mehmet Kanbay

Research output: Contribution to journalArticlepeer-review

55 Citations (Scopus)

Abstract

Aim: Pruritus is common in dialysis patients. Peripheral neuropathy is also prevalent in this patient population. However, the role of neuropathy in the genesis of uraemic itch has not been adequately studied to date. Therefore, we aimed to investigate the effects of gabapentin and pregabalin on uraemic pruritus along with neuropathic pain in patients receiving haemodialysis. Methods: This is a 14 week long randomized, prospective, cross-over trial. Haemodialysis patients with established neuropathy and/or neuropathic pain were included. Fifty patients were randomly assigned to gabapentin 300 mg after each haemodialysis session and pregabalin 75 mg daily. After 6 weeks of treatment, cross-over was performed and patients received the other drug for another 6 weeks. Short Form of McGill Pain Questionnaire and Visual Analogue Scale were used to evaluate pain and pruritus, respectively. At each week's visit, patients were interrogated in terms of adverse effects of study drugs. Baseline laboratory data and demographic characteristics were recorded from patient charts. Results: Forty (12 males, 28 females) out of 50 patients completed the study. Mean age was 58.2 ± 13.7. Overall, 29 out of 40 patients (72.5%) had pruritus symptoms at baseline evaluation. Fifteen patients (37.5%) were diabetic. Thirty-one out of 40 patients (77.5%) had electromyography (EMG)-proven peripheral neuropathy. Twenty three patients (57.5%) had both EMG-proven neuropathy and pruritus. Gabapentin and pregabalin improved both neuropathic pain and pruritus significantly. There was no difference between the study drugs in terms of efficacy against pain and pruritus. Conclusion: Treatment of neuropathic pain with either pregabalin or gabapentin effectively ameliorates uraemic itch. This paper examines the complex relationship betwen peripheral neuropathy and itch in patients receiving haemodialysis and considers whether treatment with gabapentin or pregabalin provides effective therapy. Either treatment was useful for modification of both pruritus and neuropathic pain. Further trials are required to explore this in greater detail.

Original languageEnglish
Pages (from-to)710-717
Number of pages8
JournalNephrology
Volume17
Issue number8
DOIs
Publication statusPublished - Jan 1 2012
Externally publishedYes

Keywords

  • gabapentin
  • haemodialysis
  • itch
  • peripheral neuropathy
  • pregabalin
  • pruritus

ASJC Scopus subject areas

  • Nephrology

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