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Background: Although chronic kidney disease-associated pruritus (CKD-aP) remains a frequent and frustrating symptom in patients with advanced kidney diseases, its optimal treatments are not well defined. Based on its mechanism of action, as a histamine-1 (H1), 5-(hydroxytryptamine) HT2, and 5HT3-receptor blocker, mirtazapine may be effective in the treatment of CKD-aP. Hence, this study aimed to investigate the efficacy of mirtazapine for the treatment of pruritus in patients undergoing hemodialysis (HD). Methods: A before–after clinical trial was conducted from September 2018 until March 2019, on 30 HD-patients that had been referred to the HD ward of a tertiary hospital, in Hamadan, Iran. After the 2-week washout period, mirtazapine was administered with a dosage of 15 mg/day for an additional 2 weeks. At baseline and at each dialysis session, the effects of the mirtazapine on the pruritus severity based on the visual analogue scale (VAS) and degree of sleep interference resulting from the pruritus were asked and recorded. Additionally, at the baseline and the end of 2 weeks of treatment, the serum histamine and serotonin levels, as the main chemical pruritogens evoking pruritus symptoms, were also determined. Results: Twenty-seven patients completed the entire course of the study. Based on the general linear model analysis, a progressive decline in the mean VAS score was observed over time during the study. The mean VAS score decreased from 8.48 ± 1.01 at baseline to 1.04 ± 0.79 at the end of treatment (P-value< 0.001). Similarly, the mean sleep interference scores were also significantly improved throughout treatment (decreased from 8.07± 1.43 to 2.81± 0.74; P-value< 0.001). Further, at the end of the treatment, a noticeable decrement in the serum histamine level was also seen (P-value = 0.006). The drug was acceptably well-tolerated and a majority of the patients were satisfied with this treatment. Conclusion: This pilot study suggests that mirtazapine may be an effective treatment option for the management of CKD-aP. However, further studies would be needed to confirm these results. [ABSTRACT FROM AUTHOR]

Aims and objectives To test the efficacy of narrowband ultraviolet B phototherapy in reducing renal pruritus. Background Renal pruritus is a disabling symptom affecting approximately 50% of patients undergoing maintenance haemodialysis. Managing refractory pruritus can be a great challenge for healthcare providers and patients as well. For patients who do not respond to conventional treatments, ultraviolet B phototherapy is considered the treatment of choice. Few investigators, however, have studied the efficacy of narrowband ultraviolet B phototherapy in this condition. Design The study was based on a quasi-experimental design with repeated measures. Methods A convenience sample of 42 haemodialysis patients with pruritus was recruited from haemodialysis units of a general hospital in Taipei, Taiwan. Two groups were created according to the dates of haemodialysis. The intervention participants received narrowband ultraviolet B phototherapy three times a week for two weeks. The control participants were maintained on their prior pruritus treatment. The pruritus intensity was measured with a numerical rating scale at baseline and on alternating days for seven times. Data were collected during the year 2008. Results The generalised estimating equation showed statistically significant group-by-time interactions in pruritus intensity. Using the control group as the reference group and baseline as the reference time, the intervention group had significantly lower pruritus intensity than the control group: 3·14 ( p < 0·001) at time seven, 1·71 ( p < 0·001) at time six and 1·24 at time five ( p < 0·001). The group-by-time interactions were statistically significant after four sessions of narrowband-UVB irradiation. Conclusion The study findings support the efficacy of narrowband ultraviolet B phototherapy in alleviating renal pruritus. Relevance to clinical practice Clinicians may consider prescribing phototherapy for haemodialysis patients who have intractable renal pruritus and do not respond to conventional treatments. [ABSTRACT FROM AUTHOR]