The Utilization of Gabapentin and Pregabalin for the Treatment of CKD-Associated Pruritus and Other Indications in Manitoba
Bibliographic record
Abstract
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%). Conclusions: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".