Pain and Analgesic Use in Patients With Chronic Kidney Disease Not on Dialysis: A Systematic Review

Chronic pain is common in patients with chronic kidney disease (CKD), yet pain management in non-dialysis-dependent CKD (NDD-CKD) is underexplored. Inappropriate analgesic use poses significant risks in this population.

To evaluate patterns of analgesic use-specifically opioids and NSAIDs-and associated clinical characteristics in patients with NDD-CKD.

A systematic review was conducted following PRISMA 2020 guidelines. Databases including PubMed and ClinicalTrials.gov were searched in December 2024 using MeSH terms related to CKD, analgesics, opioids, and NSAIDs. Inclusion criteria targeted NDD-CKD patients with reported analgesic use. Data extraction and risk of bias assessments were performed independently by two reviewers.

Nine studies encompassing 3,674,959 patients were included. Opioid use was reported in 324,111 patients (22.8%), while NSAIDs were used in 1,095,052 (77.1%). Opioid use increased with CKD severity and pain intensity, but was associated with higher mortality, especially in frail or comorbid patients. NSAID use was prevalent in early-stage CKD and associated with nephrotoxic risk and may occur without clinician oversight. Regional variation and inconsistent prescribing practices were noted. No study directly compared opioid vs. NSAID outcomes.

Analgesic use in NDD-CKD is widespread and varies by region, CKD stage, and pain severity. Inadequate pain control is common. Standardized guidelines tailored to CKD patients are urgently needed to optimize pain management while minimizing harm.