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Montelukast Versus Gabapentin for Uremic Pruritus in Twice-Weekly Hemodialysis Patients: A 52-Week Prospective
Bilal Mohsin1, Muhammad Ahmad2, Irfan Rasool2
1Nephrology Section, Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Hemodialysis International. International Symposium on Home Hemodialysis
|July 24, 2026
Summary
Montelukast offers a well-tolerated and effective treatment for uremic pruritus (UP) in patients undergoing twice-weekly hemodialysis. This study found montelukast provided sustained relief with fewer adverse events compared to gabapentin, making it a practical option, especially in resource-limited settings.
Area of Science:
- Nephrology
- Dermatology
- Pharmacology
Background:
- Uremic pruritus (UP) is a common complication for end-stage renal disease (ESRD) patients on maintenance hemodialysis.
- Twice-weekly hemodialysis, common in low- and middle-income countries, can exacerbate UP burden.
- Gabapentin, a common UP treatment, has limitations due to central nervous system adverse effects and poor tolerability in older populations.
Purpose of the Study:
- To compare the efficacy and safety of montelukast versus gabapentin for treating uremic pruritus.
- To evaluate treatment outcomes over a 52-week follow-up period in patients receiving twice-weekly hemodialysis.
Main Methods:
- A prospective, open-label, non-randomized study included 195 adult patients with refractory UP on twice-weekly hemodialysis.
- Patients received either montelukast or gabapentin based on clinical and demographic criteria.
- Pruritus severity was measured using the Visual Analogue Scale (VAS) at multiple follow-up points up to 52 weeks.
Main Results:
- Both montelukast and gabapentin significantly reduced VAS scores (p < 0.001).
- Montelukast showed significantly fewer adverse events and treatment discontinuations compared to gabapentin.
- Gabapentin required dose escalation in 44.7% of patients within 6 weeks; common side effects included somnolence, fatigue, and dizziness.
Conclusions:
- Montelukast provides sustained, clinically meaningful improvement in uremic pruritus with superior tolerability and fewer adverse events than gabapentin.
- While gabapentin showed slightly greater itch reduction at times, the difference was not clinically significant.
- Montelukast is a practical, well-tolerated therapeutic option for uremic pruritus, particularly in resource-limited settings.