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

Abstract

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.

Citation

Wilcock, A., Charlesworth, S., Twycross, R., Waddington, A., Worthington, O., Murtagh, F. E., Beavis, J., King, S., Mihalyo, M., & Kotlinska-Lemieszek, A. (2017). Prescribing non-opioid drugs in end-stage kidney disease. Journal of pain and symptom management, 54(5), 776-787. https://doi.org/10.1016/j.jpainsymman.2017.08.014

• 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: Aug 28, 2018
• Journal: Journal of pain and symptom management
• Print ISSN: 0885-3924
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 54
• Issue: 5
• Pages: 776-787
• DOI: https://doi.org/10.1016/j.jpainsymman.2017.08.014
• Keywords: End-stage kidney disease; Kidney failure; Opioids
• Public URL: https://hull-repository.worktribe.com/output/456521
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0885392417304190
• 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.
• Contract Date: Nov 15, 2017