No severe adverse events were reported for any intervention. Older, smaller RCTs often failed to follow intention-to-treat protocols with unexplained dropouts after randomisation.Īdverse effects were generally poorly and inconsistently reported across all RCTs. Six studies have disclosed significant financial support from their respective manufacturers, six were affected by lack of blinding, and 11 studies have 15 participants or less. For all other interventions, the certainty of the evidence was low to moderate, and the interventions had uncertain effects on uraemic pruritus.
Reduction in the severity of itch was reported with oral montelukast, turmeric, zinc sulfate and topical capsaicin. Ondansetron had little or no effect on itch scores (3 studies, 183 participants: 0.38 cm reduction, 95% CI 1.04 lower to 0.29 higher in VAS compared to placebo high certainty evidence). Kappa opioid agonists, including nalfurafine also reduced itch in this population (6 studies, 661 participants: 1.05 cm reduction, 95% CI 1.40 to 0.71 lower in VAS compared to placebo high certainty evidence). GABA analogues including, gabapentin and pregabalin, reduce itch in patients with CKD (5 studies, 297 participants: 4.95 cm reduction, 95% CI 5.46 to 4.44 lower in VAS compared to placebo high certainty evidence). The 10 cm Visual Analogue Scale (VAS) was the dominant instrument utilized for itch reporting and the Duo score was used in a minority of studies. Of these, 30 compared an intervention to a placebo or control.
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Fifty-eight studies (3285 participants) provided sufficient data to be meta-analysed. Hydrocortisone is a steroidal medicine that may be effective in reducing hives and other skin signs of allergy attacks. Ninety-two RCTs, randomising 4466 participants were included. Other intervention either do not work, do not work as well, or need further study to make a conclusion. Further meaningful assessment on harm cannot be made.ĭrugs that work like neurotransmitters (gabapentin and pregabalin) reduce itch in patients with CKD. However, none of the adverse effects documented were severe. The studies seldom document a comprehensive list of adverse or side effects incurred during treatment.
The other treatments studied are of lower to moderate quality. The three drugs mentioned above are well studied with higher quality evidence. There is too little information on the remaining treatments for any thorough assessment of their efficacy in relieving itch or whether there is any anti-itch effect at all. Kappa-opioid drugs (nalfurafine) appear to slightly reduce itch. Ondansetron, an anti-nausea drug, was another well studied treatment and appears have no significant association with itch reduction. One type of drug (gabapentin and pregabalin), an analogue to a common neurotransmitter appear to reduce itch in patients with CKD. The control treatment was either placebo or (less commonly) another treatment for CKD-associated itch.
We found 92 studies involving 4466 people investigating 30 treatments for CKD-associated itch. There are no widely used or agreed upon treatment guidelines for itch associated with CKD. Itch can greatly affect quality of life and may lead to depression or increased risk of death. doi:10.Itch (medical term pruritus) is a common problem for people with chronic kidney disease (CKD). Protocol for the systematic review of the prevention, treatment and public health management of impetigo, scabies and fungal skin infections in resource-limited settings. Lidocaine contact allergy is becoming more prevalent. Anesthetic, Local (Topical Application Route). Thurmond RL, Kazerouni K, Chaplan SR, Greenspan AJ. Rational and ethical use of topical corticosteroids based on safety and efficacy.
Systemic side-effects of topical corticosteroids. Pruritus: progress toward pathogenesis and treatment. Song J, Xian D, Yang L, Xiong X, Lai R, Zhong J.
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