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Table 1 Characteristics of included studies

From: Gabapentin for uremic pruritus in hemodialysis patients: a qualitative systematic review

Authors (year) Design Patient characteristics Previous medication trialed Exclusion Gabapentin regimen Efficacy outcomes Quality assessment Safety outcomes (n)
Level I evidence
Gunal et al. (2004) [17] R DB PC cross-over N = 25
HD 3×/week, 4–5-h sessions
Kt/V 1.37 ± 0.35 (0.5–1.93)
Males 56.0 %
Mean age 55 ± 11 (32–77)
Baseline:
Ca 2.15 ± 0.23 mmol/L
PO4 1.45 ± 0.39 mmol/L
iPTH 20.5 ± 14.3 pmol/L
Refractory to antihistamines, nicergoline, moisturizers NR Gabapentin 300 mg 3× weekly post-HD × 4 weeks, then 1-week washout, then placebo × 4 weeks vs. the reverse In chronological order:
Baseline VAS (0–10) 8.5 ± 0.94
After 4 weeks placebo 7.6 ± 2.6 (p = 0.098)
After 1-week washout 7.9 ± 1.1
After 4 weeks gabapentin 1.2 ± 1.8 (p = 0.0001)
Follow-up: 9 weeks
3a Mild to moderate somnolence, dizziness, fatigue
Naini et al. (2007) [19] RCT DB PC N = 34
HD 2×/week
Males 47.1 %
Mean age 62 ± 10 (43–81)
Refractory to antihistamines Hgb < 70 g/L,
PTH > 33 pmol/L,
PO4 > 2.26 mmol/L,
Other skin disease
Gabapentin 400 mg 2× weekly post-HD vs. placebo × 4 weeks Baseline VAS (0–10) 7.2 ± 2.3
After 4 weeks 6.7 ± 2.6 vs. 1.5 ± 1.8 (p < 0.001)
Follow-up: 4 weeks
4a Mild to moderate somnolence, dizziness, nausea
Tol et al. (2010) [20] R blinded cross-over N = 14
HD 3×/week, 4–5-h sessions
Kt/V 1.33 ± 0.17 (1.0–1.7)
Males 50 %
Mean age 59.7 ± 17.2 (41–88)
Baseline:
Ca 2.23 ± 0.18 mmol/L
PO4 1.62 ± 0.29 mmol/L
iPTH 31.68 ± 12.87 pmol/L
Refractory to antihistamines, nicergoline, moisturizers <18 years old, pregnant/lactating Gabapentin 300 mg 3× weekly post-HD × 8 weeks, then 1-week washout, then placebo (unknown duration) Pruritus VAS score (0–10):
Before gabapentin 7.6 ± 1.2
After gabapentin 1.3 ± 1.4 (p < 0.01)
Follow-up: NR
2a No side effects observed
Level II-1 evidence
Razeghi et al. (2009) [18] DB PC single-arm cross-over N = 34
HD 3×/week, 4-h sessions
Kt/V 1.31 ± 0.2
Males 23 %
Mean age 58.4 ± 12.5 (28–73)
Baseline:
Ca 2.38 ± 0.63 mmol/L
PO4 2.02 ± 0.75 mmol/L
iPTH 12.2 ± 11.33 pmol/L
Refractory to antihistamines and moisturizers Skin lesions, metabolic diseases, drug allergies, non-compliance Gabapentin 100 mg 3× weekly post-HD × 4 weeks, then 1-week washout, then placebo × 4 weeks In chronological order:
Baseline VAS (0–100) 100
After 4 weeks gabapentin 6.4 ± 8.5 (p < 0.001)
After 1-week washout 15 ± 11.3 (p < 0.001)
After 4 weeks placebo 81.9 ± 11.1 (p < 0.001)
Follow-up: 9 weeks
2a Dizziness, drowsiness, and fatigue (2)
Marquez et al. (2012) [14] Quasi-randomize, OL cross-over N = 19
HD 3×/week, 4-h sessions
Kt/V 1.23 ± 0.3
Males: NR
Mean age 54 ± 18
Baseline:
Ca 2.35 ± 0.3 mmol/L
PO4 1.65 ± 0.53 mmol/L
iPTH 5.79 ± 5.0 pmol/L
NR Chronic skin or liver diseases, malignancy, chronic opiates or corticosteroids Gabapentin 300 mg 3× weekly post-HD × 3 weeks, then 1-week washout, then desloratadine 5 mg 3× weekly × 3 weeks, vs. the reverse Baseline VAS (0–10) 5.95
After 3 weeks gabapentin 4.6 (p = 0.07)
After 3 weeks desloratadine 3.44 (p = 0.004)
Follow-up: 7 weeks
1a Fatigue and somnolence (9)
Medication discontinuation (4)
Level II-2 evidence
Rayner et al. (2012)[15] Step-wise OL N = 40 HD (71 including PD and CKDND)
Kt/V: NR
Males 77.5 %
Median age 64 (35–88)
Baseline:
Ca 2.45 mmol/L
PO4 1.54 mmol/L
iPTH 25.3 pmol/L
Refractory to emollients or antihistamines 58 % of HD patients tried antihistamines NR Gabapentin 100 mg daily post-HD, adjusted to efficacy and tolerability; final median 700 mg/week
Min: 100 mg post-HD
Max: 900 mg daily
Significant reduction of itch 31 (77.5 %)
Median follow-up: 2.5 months
5b Unknown adverse event (8)
Chiekh Hassan et al. (2015)[16] R, cohort N = 13 HD with pruritus (15 total)
Kt/V: NR
Males 73.3 %
Mean age 70.1 ± 10.6
Baseline:
Ca 2.26 ± 0.2 mmol/L
PO4 1.6 ± 0.5 mmol/L
iPTH 16.8 pmol/L (IQR 11.3–23.9)
NR Identifiable non-CKD cause of RLS or pruritus, incomplete/missing data, on gabapentin prior to attending institution Gabapentin 100 mg q2d, adjusted by 25 mg for efficacy and tolerability
Final average 90 mg/day
POS-S Renal score (pruritus):
Baseline 17.9
Subsequent visits: NR, p < 0.05
Follow-up: 27 weeks
6b Unsteadiness (2)
Blurred vision (1)
  1. Ca calcium, CKD chronic kidney disease, CKDND chronic kidney disease non-dialysis, DB double-blind, HD hemodialysis, Hgb hemoglobin, h hour(s), iPTH intact parathyroid hormone, IQR interquartile range, Kt/V number used to quantify hemodialysis treatment adequacy, NR not reported, OL open-label, PC placebo-controlled, PD peritoneal dialysis, PO 4 phosphate, R randomized, RCT randomized controlled trial, SB single-blinded, VAS visual analog scale
  2. aJadad score (0–5)
  3. bNewcastle Ottawa score (0–9)