Gabapentin Utilization and Adverse Effects Among US Hemodialysis Patients Diagnosed With Pruritus or Neuropathic Pain

Gabapentinoids, including gabapentin and pregabalin, are indicated for patients with neuropathic pain and are also prescribed off-label to treat chronic kidney disease-associated pruritus in hemodialysis (HD) patients. With limited data on effectiveness in pruritus and concerns about adverse effects, the risk-benefit profile is controversial.

A retrospective analysis of registry data.

A total of 533,232 HD patients from the United States Renal Data System from 2016-2020.

Gabapentinoid use/dose, updated over time based on prescription changes.

Five adverse effects based on ICD-10 codes: altered mental state, dizziness, fracture, falls, somnolence.

We investigated gabapentinoid utilization patterns and associations between dose and adverse effects using Cox-based recurrent event Anderson-Gill models. Analyses were adjusted for potential confounders and stratified by time-updated diagnosis groups (NP vs pruritus).

Among patients with neuropathic pain, 19% used gabapentin with a mean dose 503 mg/day. Among patients with pruritus, 11% used gabapentin with mean dose 433 mg/day. Event rates (per 100 patient-years) for adverse effects were 37.8 for altered mental state, 20.4 for falls, 19.3 for dizziness, 15.2 for somnolence, and 9.3 for fracture. Adjusted models showed a clear dose-response association (P < 0.001) between gabapentin dose and all adverse effects-especially among patients with pruritus-with elevated risk observed at doses as low as 100 mg/day. Pregabalin use was only 2%, with a dose-response adverse effect profile similar to gabapentin.

Under-ascertainment of pruritus via diagnosis codes; residual confounding.

Gabapentinoid utilization patterns differed by diagnosis, with use and doses higher among those with neuropathic pain versus pruritus. Adverse effects-even at low doses-were common, particularly when used off-label in patients with pruritus and no neuropathic pain. With new alternatives available, prescribers should weigh the clinically relevant adverse effects of gabapentinoids when providing treatment options to patients with pruritus.