Uremic pruritus in hemodialysis patients: treatment with desloratidine versus gabapentin

introduction: uremic pruritus is common among dialysis patients. effective treatments are not readily available. early evidence with antihistamines and gabapentin indicate variable effects. objective: to compare the efficacy and side effects of gabapentin and desloratadine in patients with dialysis pruritus. methods: prospective, open-label, cross-over clinical trial in 22 patients on chronic hemodialysis with sustained pruritus over a period of at least 60 days. after a one-week run-in period, we assigned patients to three weeks of either gabapentin 300 mg thrice weekly or desloratadine 5 mg thrice weekly. after a one-week washout period, each patient crossed-over to the alternate regimen for three more weeks. the primary endpoint of the study was the change in the visual analogue pruritus score (vas). results: nineteen subjects completed the two treatment blocks and were available for analysis. vas scores decreased with both treatments (5.95 to 4.6 with gabapentin, p = 0.07; 5.89 to 3.4 with desloratadine, p = 0.004), but only desloratadine reached statistical significance. there were no differences when comparing the final pruritus score with gabapentin and desloratadine (4.6 versus 3.4, p = 0.16) excessive sedation was common with gabapentin. desloratadine was well tolerated. conclusion: desloratadine provides significant relief of uremic pruritus compared with no therapy. gabapentin has marginal efficacy. desloratadine is better tolerated than gabapentin.