Management of Neuropathic Pain in Dialysis Patients: An Effective Approach with Gabapentin

Hemodialysis patients frequently complain of restless legs syndrome (RLS), hypoesthesia, or pruritus—all of which are attributed to a nervous system disorder due to kidney dysfunction or even to coexistent diseases. These symptoms are difficult to manage and they respond poorly to conventional treatment. In this study, we administered gabapentin, a novel antiepileptic drug which is excreted at 98% unaltered by the kidneys, to 7 hemodialysis patients (4 female, 3 male) from 65 to 75 years of age and at 65 to 70 kg of body weight who suffered from restless legs syndrome (4 patients), pruritus (1 patient), neuralgia (1 patient), and carpal tunnel syndrome (1 patient). Recommended dosing with adjustments for the degree of kidney failure provoked severe somnolence and dizziness affecting all patients. On an “observe and treat” basis, we determined the optimum dose was 50% lower than the suggested dose. Patients responded rapidly with significant improvement on the lower dose schedule. A follow‐up period of 8 to 32 months confirmed the good outcome. We determine that administration of gabapentin at bedtime, only on dialysis days, eliminates the side effects with concomitant impressive results. Body weight does not seem to play a major role. No additional dose was needed after the dialysis session.