Background Gabapentin and pregabalin are used to manage neuropathic pain, pruritus, and restless legs syndrome in patients on hemodialysis. These patients may be especially predisposed to complications related to these agents, which are renally cleared, but data regarding the risk thereof are lacking.

Methods From the US Renal Data System, we identified 140,899 Medicare-covered adults receiving hemodialysis with Part D coverage in 2011. Using Cox regression models in which we adjusted for demographics, comorbidities, duration of exposure, number of medications, and use of potentially confounding concomitant medications, we investigated the association between gabapentin and pregabalin, modeled as separate time-varying exposures, and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture. We evaluated risk according to daily dose categories: gabapentin (>0–100, >100–200, >200–300, and >300 mg) and pregabalin (>0–100 and >100 mg).

Results In 2011, 19% and 4% of patients received gabapentin and pregabalin, respectively. Sixty-eight percent of gabapentin or pregabalin users had a diagnosis of neuropathic pain, pruritus, or restless legs syndrome. Gabapentin was associated with 50%, 55%, and 38% higher hazards of altered mental status, fall, and fracture, respectively, in the highest dose category, but even lower dosing was associated with a higher hazard of altered mental status (31%–41%) and fall (26%–30%). Pregabalin was associated with up to 51% and 68% higher hazards of altered mental status and fall, respectively.

Conclusions Gabapentin and pregabalin should be used judiciously in patients on hemodialysis, and research to identify the most optimal dosing is warranted.

背景加巴喷丁和普瑞巴林可用于治疗血液透析患者的神经性疼痛，瘙痒和不安腿综合征。这些患者可能特别容易发生与这些药物相关的并发症，这些并发症已通过肾脏清除，但缺乏有关其风险的数据。

方法从2011年美国肾脏数据系统中，我们识别出140,899名接受Medicare覆盖的成年人接受了血液透析，其D部分覆盖范围。使用Cox回归模型，我们对人口统计学，合并症，暴露时间，药物数量以及潜在混杂因素进行了调整。伴随药物的使用，我们调查了加巴喷丁和普瑞巴林之间的关联，建模为单独的随时间变化的暴露，以及因精神状态，跌倒和骨折而首次去急诊室或住院的时间。我们根据每日剂量类别评估风险：加巴喷丁（> 0–100，> 100–200，> 200–300和> 300 mg）和普瑞巴林（> 0–100和> 100 mg）。

结果2011年，分别有19％和4％的患者接受加巴喷丁和普瑞巴林治疗。加巴喷丁或普瑞巴林使用者中有68％的患者被诊断出患有神经性疼痛，瘙痒或不安腿综合症。在最高剂量类别中，加巴喷丁与精神状态改变，跌倒和骨折的危险性分别增加50％，55％和38％，但剂量更低甚至与精神状态改变的危险性更高（31％ –41％）和下降（26％–30％）。普瑞巴林与精神状态和跌倒改变分别带来高达51％和68％的较高危险。

结论加巴喷丁和普瑞巴林应谨慎用于血液透析患者，因此有必要进行研究以确定最佳剂量。