REFRACTORY UREMIC PRURITUS: PREGABALIN, A PROMISING THERAPY.

Uremic pruritus is one of the most troublesome symptom associated with uremia. There are reports of significant relief with use of Gabapentin in refractory uremic pruritus. But many patients experience sedation and dizziness with use this agent. Incidence of such side effects is less with pregabalin. There is paucity of information about efficacy of pregabalin in uremic pruritus. Therefore we conducted this study to evaluate efficacy of pregabalin in patients of end stage renal disease (ESRD) with refractory pruritus. Materials and Methods: Study group comprised of 21 patients on maintenance hemodialysis (MHD) They had severe pruritus refractory to traditional measures like charcoal, antihistaminics and xylocaine etc. They received 75 mg pregabalin daily. Their pruritus score was calculated before starting therapy. It was calculated 7 days and 14 days after treatment. VAS score was also calculated on same visits on 10 mm line. Besides this their demographic profile, dialysis dose, S.Calcium, S.Phosphorus, S.PTH were also recorded. Any side effect like dizziness, sedation or weight gain was also recorded. Results: Mean age of patients was 42±18.2 years. Gender ratio was 2.2: 1(M:F). Causes of ESRD were DM 38% (n= 8), Chronic glomerulonephritis 23.8% (n= 5), Chronic interstitial nephritis 19% (n=4) and others 19% (n=4). All patients were on maintenance hemodialysis. Their mean kt|v was 1.28±.12. Their mean S. Ca, S. P were 8.98±1.21 mg% and 4.9±1.13 mg% respectively. Their mean S. PTH was 164±36.4 pg/ml. Mean duration of hemodialysis was 10+ 4 months. Their pruritus score before treatment was 16.4±1.99 (range 14-19). The pruritus score was 13.76±1.76 (range 10-16) after 1 week of therapy and it was 10.28±1.24 (range 7-12) after 2 weeks of therapy. We compared baseline pruritus score to score at I week (P=0.003) and at 2 weeks (P=0.003). VAS score also showed significant improvement from baseline. The VAS score before treatment was 6.94.1.6. It was 4.84.1.9 after 1 week of treatment and score was 3.8 4.1.7 after 4 weeks of treatment. 3 patients complained of dizziness and vertigo during treatment and they were managed by increasing the dose interval of drug to 36 hours. Significant weight gain was not observed in any patient. Conclusion: Use of pregabalin is associated with significant symptomatic relief in refractory uremic pruritus and no significant side effects were observed. [ABSTRACT FROM AUTHOR]