Treatment of Uremic Pruritus: A Systematic Review

Abstract

Background: Uremic pruritus is a common and burdensome symptom afflicting patients with advanced chronic kidney disease (CKD) and has been declared a priority for CKD research by patients. The optimal treatments for uremic pruritus are not well defined.

Study design: Systematic review.

Setting & population: Adult patients with advanced CKD (stage ≥ 3) or receiving any form of dialysis.

Selection criteria for studies: PubMed, CINAHL, Embase, International Pharmaceutical Abstracts, Scopus, Cochrane Library, and ClinicalTrials.gov from their inception to March 6, 2017, were systematically searched for randomized controlled trials (RCTs) of uremic pruritus treatments in patients with advanced CKD (stage ≥ 3) or receiving any form of dialysis. 2 reviewers extracted data independently. Risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool.

Intervention: Any intervention for the treatment of uremic pruritus was included.

Outcomes: A quantitative change in pruritus intensity on a visual analogue, verbal rating, or numerical rating scale.

Results: 44 RCTs examining 39 different treatments were included in the review. These treatments included gabapentin, pregabalin, mast cell stabilizers, phototherapy, hemodialysis modifications, and multiple other systemic and topical treatments. The largest body of evidence was found for the effectiveness of gabapentin. Due to the limited number of trials for the other treatments included, we are unable to comment on their efficacy. Risk of bias in most studies was high.

Limitations: Heterogeneity in design, treatments, and outcome measures rendered comparisons difficult and precluded meta-analysis.

Conclusions: Despite the acknowledged importance of uremic pruritus to patients, with the exception of gabapentin, the current evidence for treatments is weak. Large, simple, rigorous, multiarm RCTs of promising therapies are urgently needed.

Keywords: Uremic pruritus; chronic kidney disease (CKD); dialysis; end-stage renal disease (ESRD); gabapentin; randomized control trials (RCTs); systematic review.