Table 3.
Effective treatments to decrease the severity of uremic pruritus in dialysis patients
| Drug or Therapy | Dose Range | Ref. | Year | Number of Patients | Outcome: Percent Decrease in Mean Pruritus Score (Based on VAS) | Comments |
|---|---|---|---|---|---|---|
| Gabapentin | 100–300 mg given PO three times per week after each dialysis session | 20 | 2004 | 25 | 86% decrease in the treatment group versus 9.5% in controls | Used 300 mg PO three times per week for 1 mo |
| 21 | 2007 | 34 | 92.8% decrease in the treatment group versus 21% in controls | Used 400 mg PO two times per week after each dialysis session for 1 mo | ||
| 22 | 2009 | 34 | 93.5% decrease in the treatment group versus 18% in controls | Used 100 mg PO three times per week for 1 mo | ||
| Pregabalin | 25–75 mg PO daily | 23 | 2010 | 16 | 77.2% decrease | Prospective trial without control group; used 25 mg PO daily for 1 mo |
| 24 | 2012 | 50 | 79.2% decrease in pregabalin group versus 77.9% decrease in gabapentin group (equivalent efficacy) | All participants had established peripheral neuropathy and/or neuropathic pain | ||
| Crossover trial: 25 participants on pregabalin 75 mg PO daily for 6 wks followed by a 2-wk washout period and then 6 wks of gabapentin 300 mg PO given three times per week post-HD sessions; 25 participants started with gabapentin | ||||||
| 25 | 2012 | 12 | 69% decrease | Prospective trial without control group; used 25 mg PO three times per week (if ineffective, dose ↑ to 25–50 mg PO daily for 24 wks) | ||
| Nalfurafine | 5 µg iv three times per week directly after each HD session | 26 | 2005 | 144 | 40% decrease in treatment group versus 19% in control group | Study I: Parallel group design, 1-mo duration, 5 µg iv three times per week directly after each HD session |
| Study II: Crossover design, 2-wk treatment period, 3-wk washout period, 1-wk run-in period, and 2-wk treatment period; results of both studies similar | ||||||
| 2.5–5 µg PO nightly | 27 | 2010 | 337 | 35.4% decrease in treatment group versus 20% in control group | Used 2.5 or 5 µg PO nightly for 2 wks; results between different dosing groups were the same | |
| 28 | 2012 | 211 | 58.9% decrease | Open-label, single-arm, prospective trial; used 5 µg PO nightly for 52 wks | ||
| Cromolyn | 135 mg PO TID | 29 | 2010 | 62 | 89.6% decrease in treatment group versus 34.2% in control group | 8-wk trial |
| Topical cromolyn sodium 4% cream daily | 30 | 2012 | 60 | 88% decrease in treatment group versus 51.6% in control group | 4-wk trial | |
| Sericin cream | Sericin 8% cream BID | 31 | 2012 | 50 | 68.4% decrease in treatment group | Intersubject control using a split-body biometrological assessment. |
| 6-wk trial | ||||||
| High-permeability HD | High-permeability dialyzers | 32 | 2009 | 116 | 69.3% decrease in treatment group versus 11.5% in control group | HD was performed three times per week for 12 wks; high-permeability dialyzers (F60; Fresenius) were used, with polysulphone membranes of 1.3 m2 and an ultrafiltrate coefficient of 40 ml/h per mmHg |
| Capsaicin | Capsaicin 0.03% ointment | 33 | 2010 | 34 | Not based on VAS; 84.3% decrease in treatment group versus 52% in control group | Crossover design with 4 wks of treatment, a 2-wk washout period, and 4 wks of treatment; because of the burning sensation with the initial use of capsaicin, it is highly likely that those patients knew their group assignment. |
| Four times per day | Did not use VAS; scored pruritus based on severity, distribution, and sleep disorder | |||||
| Pramoxine | Pramoxine 1% lotion BID | 34 | 2009 | 28 | 61% decrease in treatment group versus 12% in control group | 4-wk trial |
| Narrow-band UVB therapy | Narrow-band UVB to whole-body surface | 35 | 2005 | 20 | 70.8% decrease in treatment group | 6-wk treatment period; open pilot trial, with only 10 patients completing the trial |
| Three times per week | 36 | 2007 | 46 | 54.2% decrease in group 1 after a mean of 22 treatments; 67.9% decrease in group 2 after a mean of 22 treatments | Open-label trial with two groups: Group 1 had 17 patients with uremic pruritus, and group 2 had 29 patients with idiopathic pruritus | |
| 37 | 2011 | 21 | 54.9% decrease in treatment group | Single-blind, randomized, controlled trial; 6-wk treatment period | ||
| Versus 59.3% in control groupa | Control group received matched UVA treatments | |||||
| Sertraline | 50 mg PO daily | 38 | 2012 | 19 | Not based on VAS; 57.8% of patients had improved pruritus severity from severe or moderate to weak | Open-label, single-arm, prospective trial for 4 mos of active treatment; severity graded by a researcher-developed 30-item inventory (content validity for this form was 0.82) |
| γ-Linolenic acid | Topical γ-linolenic acid 2.2% cream to entire body daily and TID to pruritic areas | 39 | 2006 | 17 | 51.2% decrease in treatment group (group A) versus 15% in control group (group B) | Crossover design with two groups randomized into treatment versus urea cream control; 2-wk treatment periods with a 2-wk washout period |
| After crossover, 45.51% decrease in treatment group (group B) versus 11.2% in control group (group A) | ||||||
| Thalidomide | 100 mg PO | 40 | 1994 | 29 | Not based on VAS | Crossover design; 1-wk treatment periods with a 1-wk washout period (pruritus intensity was scored TID from zero to three) |
| QHS | 78% decrease in treatment group versus no change in control group | Response in control group could be caused by placebo effect versus carryover effect | ||||
| After crossover, 81% decrease in treatment group versus 54% in control group | ||||||
| Activated charcoal | Activated powdered charcoal 6 g | 41 | 1995 | 23 | Not based on VAS | Nonrandomized, single-blind, controlled trial for 6 wks |
| PO daily | 70.4% decrease | Pruritus intensity scored from one to six; 10 patients initially given a placebo for 1 wk before all patients received treatment (data from 10 patients only) | ||||
| Glycerin and paraffin emulsion | Glycerin 15% and paraffin | 42 | 2011 | 100 | Did not compare change in VAS in period I | Period I: 7-d comparative period of test product versus plain emulsion intraindividually (left leg versus right leg) |
| 10% in an oil and water emulsion BID | 75% overall decrease at the end of open-label period (period II) | Period II: 49-d noncomparative, open-label trial of the test product to all xerotic areas BID |
All therapies listed showed a statistically significant reduction in the mean pruritus score. All are randomized, double-blind, and controlled trials unless otherwise noted in the comments. VAS, visual analog scale; PO, per os; HD, hemodialysis; iv, intravenous; TID, three times daily; BID, two times daily; UVB, ultraviolet B; UVA, ultraviolet A; QHS, nightly.
a
Lack of statistical significance could be attributed to small sample size, effect of UVA on pruritus, or placebo effect.