ReviewTherapeutics and clinical risk management2020
Safe Use of Opioids in Chronic Kidney Disease and Hemodialysis Patients: Tips and Tricks for Non-Pain Specialists.
Review in Therapeutics and clinical risk management, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 53 citations in OpenAlex.
- Strategy for effective analgesia with intravenous buprenorphine in patients with acute postoperative pain.BMC anesthesiology · 2025Pooled it
- Opioids to Treat Chronic Pain in the Older Adult: A Clinical Consensus to Guarantee Safety and Avoid Adverse Events.Drugs & aging · 2026Review
- Hydromorphone in Pediatric Pain Management: Pharmacology, Clinical Applications, and Safety Considerations-A Narrative Review.Healthcare (Basel, Switzerland) · 2026Review
- Computational Insights into the Molecular Synergy of Paracetamol and Codeine.Life (Basel, Switzerland) · 2026Article
- New hypothesis: a gut-lipid-kidney axis in constipated CKD patients-insights from multi-omics triangulation.mSphere · 2026Article
- Acthar Gel versus standard of care for adults with proteinuria in nephrotic syndrome due to focal segmental glomerulosclerosis: cost-per-response analysis from the US healthcare perspective.Journal of comparative effectiveness research · 2026Article
- Patterns of opioid dose escalation in patients with chronic kidney disease initiated on opioids for the treatment of non-cancer pain.PloS one · 2026Article
- Enhancing therapeutic strategies and drug development for patients with kidney disease.Expert opinion on drug safety · 2026Review
- A kappa opioid receptor agonist, difelikefalin, improves acute kidney injury in experimental sepsis models.PloS one · 2026Article
- Sex-specific pharmacovigilance signals and time-to-onset patterns of drug-related myoclonus and epileptic seizures: a real-world pharmacovigilance analysis.Frontiers in pharmacology · 2026Article
- Perioperative Management of the Patient Receiving Maintenance Hemodialysis.Anesthesiology · 2025Article
- Opioid use and poisoning in hospitalized patients with chronic kidney disease.Journal of nephrology · 2025Article
- Cost per Response of Acthar® Gel vs Standard of Care for the Treatment of Proteinuria in Nephrotic Syndrome Due to Idiopathic Membranous Nephropathy Among Adults from the US Healthcare Perspective.Journal of health economics and outcomes research · 2025Article
- Transdermal Fentanyl Patch Effectiveness in Postoperative PainManagement in Orthopedic Patients: Literature Review.Journal of clinical medicine · 2024Review
- Opioid system and related ligands: from the past to future perspectives.Journal of anesthesia, analgesia and critical care · 2024Review
- Symptom Burden in Patients on Maintenance Hemodialysis: Prevalence and Severity 17 Years Apart.Journal of clinical medicine · 2024Article
- Two Weeks of Continuous Opioid Treatment in an Adenine-Induced Mouse Model of Chronic Kidney Disease Exacerbates the Bone Inflammatory State and Increases Osteoclasts.Calcified tissue international · 2024Article
- Drugs with a negative impact on cognitive functions (Part 2): drug classes to consider while prescribing in CKD patients.Clinical kidney journal · 2023Review
- Review
- Novel single nucleotide polymorphism biomarkers to predict opioid effects for cancer pain.Oncology letters · 2023Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
In patients suffering from moderate-to-severe chronic kidney disease (CKD) or end-stage renal disease (ESRD), subjected to hemodialysis (HD), pain is very common, but often underestimated. Opioids are still the mainstay of severe chronic pain management; however, their prescription in CKD and HD patients is still significantly low and pain is often under-treated. Altered pharmacokinetics and the lack of clinical trials on the use of opioids in patients with renal impairment increase physicians' concerns in this specific population. This narrative review focused on the correct and safe use of opioids in patients with CKD and HD. Morphine and codeine are not recommended, because the accumulation of their metabolites may cause neurotoxic symptoms. Oxycodone and hydromorphone can be safely used, but adequate dosage adjustments are required in CKD. In dialyzed patients, these opioids should be considered as second-line agents and patients should be carefully monitored. According to different studies, buprenorphine and fentanyl could be considered first-line opioids in the management of pain in CKD; however, fentanyl is not appropriate in patients undergoing HD. Tapentadol does not need dosage adjustment in mild-to-moderate renal impairment conditions; however, no data are available on its use in ESRD. Opioid-related side effects may be exacerbated by common comorbidities in CKD patients. Opioid-induced constipation can be managed with peripherally-acting-μ-opioid-receptor-antagonists (PAMORA). Unlike the other PAMORA, naldemedine does not require any dose adjustment in CKD and HD patients. Accurate pain diagnosis, opioid titration and tailoring are mandatory to minimize the risks and to improve the outcome of the analgesic therapy.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.