The effectiveness of complementary and alternative medicine in the symptom management of pruritus in patients with end-stage kidney disease: a systematic review

Abstract

Background Uraemic pruritus is a common symptom in end-stage kidney disease ESKD with a documented poor response to standard medical treatment Patients seeking relief may self-medicate using complementary and alternative medicine CAM often without medical supervision Healthcare professionals seeking to alleviate discomfort may be reluctant to promote CAM usage due to scant evidence on efficacy and effectiveness Aim To systematically review the use of CAM for pruritus management in patients with ESKD Method MEDLINE CINAHL EMBASE Cochrane databases grey literature and hand searches occurred using specific MeSH terms Studies using CAM in the treatment of symptoms for ESKD patients experiencing pruritus were considered relevant Articles available in English written from 2000 and later were appraised using the Joanna Briggs Institute JBI critical appraisal tools Results 193 studies were screened as per the inclusion criteria 21 studies were identified 11 randomised controlled trials RCTs seven quasi-experimental two case studies and one cross-sectional Interventions studied included acupressure acupuncture aromatherapy homeopathy music therapy oral supplements thermal therapy and topical application Studies claiming consistent benefits were acupressure acupuncture and aromatherapy Conclusion CAM encompasses multiple interventions with very few studies consistent in design and measurement resulting in a gap in evidence on safety and effectiveness Further research is needed incorporating standardised validated tools to establish best practice CAM use should be discussed with patients and integrated into the health assessment process so that interventions can be safely monitored