Uraemic Pruritus: Relief of Itching by Gabapentin and Pregabalin Hugh Rayner Jyoti Baharani Steve Smith Vijayan Suresh Indranil Dasgupta

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 Received: November 27, 2012 Accepted: February 12, 2013 Published online: M arch 28, 2013 Dr. Hugh C. Rayner Heart of England NHS Foundation Trust Bordesley Green East Birmingham B9 5SS (UK) E-Mail hugh.rayner @ heartofengland.nhs.uk © 2013 S. Karger AG, Basel 1660–2110/13/1224–0075$38.00/0