ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: FR-PO422

The Utilization of Gabapentin and Pregabalin for the Treatment of CKD-Associated Pruritus and Other Indications in Manitoba

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Leon Mantilla, Silvia Juliana, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
  • Whitlock, Reid, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
  • Harasemiw, Oksana, University of Manitoba, Winnipeg, Manitoba, Canada
  • DiNella, Michelle SJ, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
  • Miciak, Gerald, Otsuka Canada Pharmaceutical Inc, Saint Laurent, Quebec, Canada
  • Bohm, Clara, University of Manitoba, Winnipeg, Manitoba, Canada
  • Komenda, Paul, University of Manitoba, Winnipeg, Manitoba, Canada
  • Tangri, Navdeep, University of Manitoba, Winnipeg, Manitoba, Canada
  • Collister, David Thomas, University of Manitoba, Winnipeg, Manitoba, Canada
  • Rigatto, Claudio, University of Manitoba, Winnipeg, Manitoba, Canada
Background

Chronic kidney disease-associated pruritus (CKD-aP) frequently affects patients on dialysis, is associated with reduced quality of life, and was identified as a research priority by patients. Until recently there were no approved treatments for CKD-aP, which was often treated with off-label therapies. Systematic reviews published in 2017-2020 identified GABA (gabapentin, pregabalin) analogues as having evidence for efficacy. This real-world study describes the prescription patterns for GABA over time and their frequency of use for CKD-aP.

Methods

Retrospective cohort study using administrative health data from Manitoba, Canada (>1.2 million residents). We included all adults (≥ 18 years) who received an incident prescription for a GABA between January 1st, 2012, and March 31st, 2022. We calculated the yearly prescription rate per new user for each GABA in total and for each of the following indications: neuropathy, seizure, fibromyalgia, restless legs syndrome (RLS), and chronic pain. Finally, we estimated the total and annual percentage of GABA prescribed for CKD-aP in the chronic dialysis population (defined as dialysis for 90 consecutive days with no gaps >15 days between sessions).

Results

In the study period, there were 125,881 GABA analogue users (adults aged 18 and over). Gabapentin was more commonly prescribed (85%) than pregabalin (15%). The number of new GABA prescriptions increased from 11,301 in 2012 to 12,031 in 2021. Only 0.7% of these were prescribed to treat CKD-aP.
There were 4,028 chronic dialysis patients included. Indications for GABA prescriptions in this group were fibromyalgia (24%), seizures (12%), neuropathic pain (9%), RLS (10%) and CKD-aP (19%). Patients receiving GABA for CKD-aP were mostly men (57%) and were older (mean age 60 vs 56 years) than those in the general population. There was a decrease in the proportion of dialysis patients receiving GABA for CKD-aP from 2017 to 2020 (4% to 2.6%) with an increase in 2021 (4%).

Conclusion

GABA are rarely used for CKD-aP (0.7% of all GABA use), despite evidence of efficacy. We speculate that safety concerns may limit GABA use. Further studies of the risks:benefit of GABA analogues in CKD-aP are needed.

Funding

  • Commercial Support – Otsuka Canada Pharmaceutical Inc.