Omega-3 fatty acids versus gabapentin in uremic pruritus in hemodialysis patients: randomized controlled, crossover clinical trial

Abstract Background Uremic pruritus (UP) is a common issue for individuals with chronic kidney disease undergoing hemodialysis (HD), mainly due to a lack of essential fatty acids. These fatty acids and their derivatives supplementation had shown positive effects, especially in promoting anti-inflammatory omega-3 fatty acids. This study aimed to evaluate the effect of omega-3 fatty acids, as opposed to gabapentin, on pruritus in HD patients. Methods Fifty prevalent HD patients were recruited from the HD Department of Ain-Shams University Hospital for a three-and-a-half-month randomized controlled crossover trial. Participants were randomized into two groups: Group A consisted of 25 patients who received omega-3 in addition to standard therapy, with calcium and erythropoietin stimulation for a 4-week treatment phase, followed by 5 weeks of washout receiving standard treatment alone. Gabapentin was subsequently administered. Group B consisted of 25 patients who received gabapentin in addition to standard therapy, which included calcium and an erythropoietin stimulant. The patients received 4 weeks of treatment, followed by a 6-week washout with only standard care. Omega-3 was given after the washout period. Results Prostaglandin E2 (PGE2) levels were significantly reduced among patients treated with omega-3 compared to gabapentin. The 5-D itch scale was significantly reduced among all patients after treatment with omega-3 or gabapentin, with no significant difference. Conclusion Omega-3 fatty acids are similarly effective as gabapentin in treating uremic pruritus. Omega-3 fatty acids show promise as an effective medication for treating pruritus in people with uremia.