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Prescribing non-opioid drugs in end-stage kidney disease

Wilcock, Andrew; Charlesworth, Sarah; Twycross, Robert; Waddington, Anne; Worthington, Olivia; Murtagh, Fliss E.M.; Beavis, Jenny; King, Samuel; Mihalyo, Mary; Kotlinska-Lemieszek, Aleksandra


Andrew Wilcock

Sarah Charlesworth

Robert Twycross

Anne Waddington

Olivia Worthington

Jenny Beavis

Samuel King

Mary Mihalyo

Aleksandra Kotlinska-Lemieszek


Palliative care services are increasingly involved in the care of patients with chronic kidney disease, either alone or as a comorbid condition. Because renal impairment often changes the pharmacokinetic and/or pharmacodynamic effects of a drug, this presents a challenge for prescribers. This article provides guidance for prescribing non-opioid drugs commonly used for palliative care symptom relief in patients with end-stage kidney disease (ESKD; i.e. Chronic Kidney Disease Stage 5, eGFR <15mL/min/1.73m²) whether or not they are receiving dialysis. Opioids are not included, nor symptom relief in the last hours–days of life, because specific guidance is available elsewhere. Tables have been produced to highlight, when possible, the most, intermediate and least ‘renally safe’ drugs for chronic use. However, sometimes the cautious use of a familiar drug may be preferable to an unfamiliar (albeit ‘renally safer’) one. Similarly, we do not advocate the automatic switching of patients to a ‘renally safer’ drug when an alternative is proving satisfactory. Finally, this article aims to complement and not replace specialist renal unit guidance.


Wilcock, A., Charlesworth, S., Twycross, R., Waddington, A., Worthington, O., Murtagh, F. E., …Kotlinska-Lemieszek, A. (2017). Prescribing non-opioid drugs in end-stage kidney disease. Journal of pain and symptom management, 54(5), 776-787.

Journal Article Type Article
Acceptance Date Aug 16, 2017
Online Publication Date Aug 24, 2017
Publication Date 2017-11
Deposit Date Nov 15, 2017
Publicly Available Date Oct 27, 2022
Journal Journal of pain and symptom management
Print ISSN 0885-3924
Electronic ISSN 1873-6513
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 54
Issue 5
Pages 776-787
Keywords End-stage kidney disease; Kidney failure; Opioids
Public URL
Publisher URL
Additional Information This is the accepted manuscript of an article published in Journal of pain and symptom management, 2017. The version of record is available at the DOI link in this record.


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