Targeting the Opioid Pathway for Uremic Pruritus: A Systematic Review and Meta-analysis

Background:Patients undergoing hemodialysis or peritoneal dialysis often experience pruritus which is associated with morbidity and mortality. One proposed treatment approach is to target the opioid pathway using either µ-opioid antagonists or κ-opioid agonists.Objective:To review the efficacy of targeting the opioid pathway for pruritus among dialysis patients (uremic pruritus).Design:Systematic review and meta-analysis.Setting/Methods:The systematic review included randomized controlled and randomized crossover trials identified in the MEDLINE, EMBASE, and Cochrane databases (1990 to June 2014) evaluating the efficacy of µ-opioid antagonists or κ-opioid agonists in the treatment of uremic pruritus.Patients:Adult (≥18 years) chronic dialysis patients.Measurements:The primary outcome being evaluated was reduction in itch severity measured on a patient-reported visual analog scale (VAS).Results:Five studies out of 3587 screened articles met the inclusion criteria. Three studies evaluated the efficacy of na...