Comparing The Efficacy And Safety Of Pregabalin Vs Gabapentin In Uremic Pruritus In Patients Of Chronic Kidney Injury Undergoing Haemodialysis.

BACKGROUND: World has been facing an epidemic of non-communicable diseases including heart, metabolic and renal diseases. Renal diseases have been commonly diagnosed and managed in low- and middle-income countries. Objective was to compare efficacy and safety of Pregabalin and Gabapentin in uremic pruritus among patients of chronic kidney injury undergoing haemodialysis. It was a comparative cross-sectional study, conducted at the Department of nephrology Abbottabad International Medical Institute. February 2021 to January 2022. METHODS: Total of 90 cases were included in the study, which were diagnosed as chronic kidney disease stage 5 undergoing haemodialysis and presented with pruritus. Pruritus was gauged on numeric rating scale and patients score of more than 6 were included. Patients were randomly divided into two groups via lottery method. Group A received Pregabalin while group B received Gabapentin. Efficacy and safety were assessed in both groups at the end of six months. RESULTS: Out of 90 dialysis dependent chronic kidney disease patients with significant pruritus included in the study, 61 (52.7%) patients were males and 29 (46.3%) were females. At the end of 6 weeks, we found out that 35 (38.9%) had no pruritus, 25 (27.8%) had mild, 19 (21.1%) had moderate while 11 (12.2%) had severe pruritus. After applying the chi-square test we found that Pregablin was statistically significantly more efficacious then Gabapentin (p-value-0.026). Sedation, nausea and blurred vision were found more in patients who took Pregabalin (p-value<0.001). CONCLUSIONS: Pregablin emerged out to be more efficacious with regards to reducing pruritus of the two medications compared in our study population while patients who took Gabapentin experience significantly a smaller number of side effects as compared to patients who were given Pregabalin.

Ultrasound Guided Tunnelled Cuffed Catheter Placement Without Fluoroscopic Guidance By Anatomical Landmarks; Accuracy And Safety.

BACKGROUND: Chronic kidney disease is a growing disease with high morbidity and mortality. Haemodialysis remains the most common option available for all those not planning for renal transplantation. Vascular access is the most important aspect of haemodialysis. Though not recommended but central venous catheters remain the most common vascular access in starters on haemodialysis. There is a growing trend towards placement of tunnelled cuffed catheters (TCC). Tunnelled cuffed catheters placement requires fluoroscopic guidance which is not available in all centres. The rationale of this study was to describe safety and accuracy of a catheter placement technique not dependent on fluoroscopic guidance for resource limited settings. METHODS: Dialysis dependent patients of a single hospital without long term vascular access were selected over a period of 15 months after getting informed written consent. A new technique was described in which depth of catheter was estimated by superficial anatomical and ultrasound guided measurements for TCC placement which were checked by conventional chest radiography post procedure. RESULTS: A total of 209 catheters were placed over a period of 15 months, 189 males and 30 females. Various sites were used predominantly right Internal jugular vein (IJV) (85.6%). Overall success rate was 97.1% (98.3% males, 90% females, p=0.08). Right IJV was successful 98.9%, left IJV 87.5% (p<0.001). Multiple thrombosed/stenosed veins were associated with higher failure rate (p<0.001). CONCLUSIONS: Tunnelled cuffed catheters can be placed successfully and safely in right IJV under ultrasound guidance using anatomical landmark measurement technique without fluoroscopic guidance.