5– 8 Nevertheless, the incidence of CKD in children is not negligible. 4 Indeed, most of the new CKD diagnoses concern people ≥65 years, in which the increased risk of renal function impairment is mainly related to the age and to the presence of comorbidities, such as diabetes mellitus, hypertension, and heart failure. The increase in the average age of the world population that occurred in the latest years highlighted the complexity of geriatric patients’ management and the increasing number of patients suffering from CKD. Many elements, such as genetic or epigenetic factors, 1, 2 age population, economic, and social disadvantage, 3 seem to have a relevant impact in the development of moderate-to-severe CKD. Accurate pain diagnosis, opioid titration and tailoring are mandatory to minimize the risks and to improve the outcome of the analgesic therapy.Ĭhronic kidney disease (CKD) is an increasing health problem worldwide. Unlike the other PAMORA, naldemedine does not require any dose adjustment in CKD and HD patients. Opioid-induced constipation can be managed with peripherally-acting-μ-opioid-receptor-antagonists (PAMORA). Opioid-related side effects may be exacerbated by common comorbidities in CKD patients. Tapentadol does not need dosage adjustment in mild-to-moderate renal impairment conditions however, no data are available on its use in ESRD. 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. In dialyzed patients, these opioids should be considered as second-line agents and patients should be carefully monitored. Oxycodone and hydromorphone can be safely used, but adequate dosage adjustments are required in CKD. Morphine and codeine are not recommended, because the accumulation of their metabolites may cause neurotoxic symptoms. This narrative review focused on the correct and safe use of opioids in patients with CKD and HD. 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. 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. 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.
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