Use of Pregabalin in the Management of Chronic Uremic Pruritus

Context. Uremic pruritus (UP) affects many patients suffering from chronic kidney disease (CKD) and has a negative impact on quality of life and survival. It has become increasingly evident that central transmission and sensitization processes similar to those observed in chronic pain are important mechanisms of pruritus. Objectives. To test the potential role of pregabalin in reducing the intensity of UP in CKD patients. Methods. We prospectively collected data on CKD patients who suffered from severe intractable pruritus. Patients were asked to record the intensity of pruritus on a visual analogue scale. Results. Twelve patients were studied. The average pretreatment pruritus score was 9.7 +/- 0.9 and decreased to 3.7 +/- 2.35, 3.2 +/- 1.75, and 3 +/- 1.5 after one, four, and 24 weeks of treatment, respectively (P<0.05). The positive effect of pregabalin was demonstrated during the first week of therapy in six patients. Most patients required 25 mg a day. Pregabalin was well tolerated, with somnolence and dizziness developing in two patients. Conclusion. We demonstrated dramatic improvement of long-standing UP after the initiation of pregabalin. We suggest that pregabalin can be used safely in CKD but careful titration of the dose is required to obtain an optimal response and minimize the possible adverse effects. (C) 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.