Division of Nephrology, Department of Internal Medicine, Meram School of Medicine, Konya University, Meram, Konya, Turkey.
Nephrology (Carlton). 2012 Nov;17(8):710-7. doi: 10.1111/j.1440-1797.2012.01655.x.
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.
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.
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.
Treatment of neuropathic pain with either pregabalin or gabapentin effectively ameliorates uraemic itch.
瘙痒是透析患者的常见症状。周围神经病变在这一患者群体中也很普遍。然而，迄今为止，神经病变在尿毒症瘙痒的发病机制中的作用尚未得到充分研究。因此，我们旨在研究加巴喷丁和普瑞巴林对接受血液透析的患者的尿毒症瘙痒和神经性疼痛的影响。
这是一项为期 14 周的随机、前瞻性、交叉试验。纳入了患有既定神经病变和/或神经性疼痛的血液透析患者。50 名患者被随机分为两组，一组在每次血液透析后给予 300 毫克加巴喷丁，另一组每天给予 75 毫克普瑞巴林。治疗 6 周后进行交叉，患者接受另一种药物治疗 6 周。使用 McGill 疼痛问卷简表和视觉模拟量表分别评估疼痛和瘙痒。每周就诊时，询问患者研究药物的不良反应。从患者病历中记录基线实验室数据和人口统计学特征。
50 名患者中有 40 名（12 名男性，28 名女性）完成了研究。平均年龄为 58.2±13.7 岁。总体而言，40 名患者中有 29 名（72.5%）在基线评估时存在瘙痒症状。15 名患者（37.5%）患有糖尿病。40 名患者中有 31 名（77.5%）存在肌电图（EMG）证实的周围神经病变。23 名患者（57.5%）同时存在 EMG 证实的神经病变和瘙痒。加巴喷丁和普瑞巴林均显著改善神经性疼痛和瘙痒。两种研究药物在缓解疼痛和瘙痒方面没有差异。
用普瑞巴林或加巴喷丁治疗神经性疼痛可有效改善尿毒症瘙痒。
