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Opioid Analgesic Use among Patients with Kidney Disease: A Systematic Review

Shania Liu1,2, Megan B Sands3, Jack W Kerferd4

  • 1The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Camperdown, New South Wales, Australia.

Kidney & Blood Pressure Research
|June 2, 2024
PubMed
Abstract

Insights

Evidence on opioid use in patients with kidney disease is limited. Morphine has the most safety data, while other opioids require greater caution due to insufficient research on safety and pain relief in renal impairment.

Area of Science:

  • Pharmacology
  • Nephrology
  • Pain Management

Background:

  • Opioid analgesics are frequently prescribed for moderate to severe pain.
  • A substantial number of patients on opioid therapy exhibit impaired kidney function.
  • Kidney disease significantly impacts drug metabolism and excretion, necessitating careful opioid selection.

Purpose of the Study:

  • To systematically review existing evidence on the safety and analgesic efficacy of opioid analgesics in adult patients with kidney disease.
  • To evaluate the available data regarding opioid use in individuals with compromised renal function.

Main Methods:

  • A comprehensive search of eight electronic databases was conducted up to January 26, 2023.
  • Included studies were original research articles in English focusing on opioid use and pharmacokinetics in adults with reduced renal function.
  • Independent screening, data extraction, and quality assessment were performed by at least two investigators.

Main Results:

  • The review included 32 observational studies.
  • Morphine was the most studied opioid (14 studies), followed by fentanyl (3 studies) and hydromorphone (2 studies).
  • Thirteen studies examined other opioids, including codeine, dihydrocodeine, and buprenorphine.

Conclusions:

  • Limited and low-quality evidence currently exists regarding opioid safety and efficacy in renal impairment.
  • Morphine demonstrates the most available evidence for safety and pain relief in patients with kidney disease.
  • Increased caution is advised for other opioids, and further high-quality research on clinical outcomes is essential.
Keywords:
Kidney diseaseOpioidPain management

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