Opioid Management in CKD

Lu, Emily; Schell, Jane O.; Koncicki, Holly M.

doi:10.1053/j.ajkd.2020.08.018

Cited by 9 publications

(10 citation statements)

References 50 publications

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“…23 This suggests that accumulation of nor-oxycodone is less likely to cause adverse events in patients with CKD, and our findings are consistent with this, thus supporting the general recommendations regarding the safety of oxycodone for patients with CKD. 8,9 No significant difference in the incidence of acute respiratory conditions was found between oxycodone and fentanyl use in this study. Fentanyl is considered safe in patients with CKD because it is excreted mainly via the liver.…”

Section: Discussioncontrasting

confidence: 54%

“…Fentanyl is considered safe in patients with CKD because it is excreted mainly via the liver. 8 Although the Japanese guidelines for cancer pain do not make specific recommendations regarding the use of transdermal fentanyl, 24 fentanyl is marketed as a transdermal formulation in Japan, and thus the fentanyl group in this study may Abbreviation: CKD, chronic kidney disease.…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, this study may include channeling bias. Morphine is generally avoided in patients with CKD, 8,9 and oxycodone may also be avoided to a greater extent than fentanyl in patients with more severe CKD based on their pharmacokinetics in CKD. Because this study could not assess the CKD stage, fentanyl may have been selected for patients with more severe CKD.…”

Section: Notementioning

confidence: 99%

“…7 Although an acute respiratory condition is a serious adverse event that is potentially fatal, oxycodone is generally considered to have a low risk of adverse events in patients with CKD compared with morphine. 8,9 Fentanyl is also generally considered to be safe in patients with CKD 8 ; however, use of fentanyl can lead to more acute respiratory conditions compared with equipotent doses of morphine, suggesting that fentanyl may be more likely to cause opioid overdose deaths. 10 However, few data are available on the association between the use of oxycodone in patients with CKD and acute respiratory conditions, and thus such information would be helpful for delineating pharmacological pain management in patients with cancer and CKD.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of different sustained‐release opioids and acute respiratory conditions in patients with cancer and chronic kidney disease

Mitsuboshi,

Imai,

Kizaki

et al. 2023

Pharmacotherapy

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Study ObjectiveFew data are available on the association between the use of oxycodone in patients with chronic kidney disease (CKD) and acute respiratory conditions. The aim of this study was to investigate whether oxycodone is associated with an increased risk of acute respiratory conditions in patients with cancer and CKD compared with other opioids.Design and SettingThe data were obtained from a claims database in Japan. Patients with cancer and CKD who had received sustained‐release opioids, including oral oxycodone, oral morphine, or transdermal fentanyl, between April 2014 and May 2021 were selected. The primary outcome was defined as an acute respiratory condition. Data for age and sex, morphine equivalent daily dose, concomitant use of specified medications, comorbidities defined based on the modified Charlson comorbidity index, substance use disorder, and lung cancer or metastatic lung cancer were investigated as covariates. Distribution of acute respiratory conditions was compared among the three sustained‐release opioid groups using the log‐rank test. Estimates of the incidence of acute respiratory conditions were compared among the groups using a Cox proportional hazards model with time‐varying variables.Main ResultsA significant difference in the distribution of acute respiratory conditions was found among the three groups (p < 0.01). Cox regression analysis showed a significantly higher risk of acute respiratory conditions with morphine (hazard ratio [HR]: 3.04, 95% confidence interval [CI]: 1.07–8.65, p = 0.04) compared with oxycodone but no significant difference in risk with oxycodone (HR 0.67, 95% CI: 0.32–1.38, p = 0.27) compared with fentanyl.ConclusionsThe findings suggest that the risk of acute respiratory conditions may be lower in patients with CKD who use oxycodone for cancer pain than in those who use morphine. Additionally, no difference in the risk of acute respiratory conditions was found between oxycodone and fentanyl use.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Notementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of different sustained‐release opioids and acute respiratory conditions in patients with cancer and chronic kidney disease

Mitsuboshi,

Imai,

Kizaki

et al. 2023

Pharmacotherapy

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“…У хворих з нирковою недостатністю відбувається накопичення активних метаболітів опіатів в організмі. Під дією опіатів знижується функція нирок й імовірно, що на фоні зниження їх перфузії, може збільшуватися виділення АДГ, підвищуватися тонус сечоводів, сечового міхура, сфінктера сечівника (спазм сфінктера сечового міхура) [30][31][32][33].…”

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Аssessment of the antinociceptive efficacy of varieties of multimodal low-opioid general anesthesia during laparoscopic renal surgery

Ovsiienko

Bondar

Лоскутов

2022

Ukr. J. Nephrol. and Dial.

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The main premise for the emergence of the concept of low-opioid general anesthesia was the phenomenon of the formation of drug/opioid dependence in patients undergoing surgery under multicomponent anesthesia with high doses of narcotic analgesics (opioids). Opioids were used as the main analgesics and in the postoperative period. The above factors contributed to the development of opiate addiction in operated patients in the late postoperative period. The mass nature of this phenomenon has become one of the most urgent problems in modern anesthesiology. Our study aimed to evaluate the antinociceptive/antistress efficacy of 3 types of low-opioid multimodal general anesthesia in laparoscopic renal surgery. Methods. Eighty patients who had undergone laparoscopic renal surgery under 3 types of general anesthesia were included in this prospective cohort study. All patients were operated under general anesthesia with tracheal intubation. Induction: intravenous (IV) propofol 2 mg/kg, fentanyl 1.5-2 μg/kg, atracurium 0.6 mg/kg. Maintenance of anesthesia: sevoflurane (MAC - 1.44±0.25% by volume). In group 1 (control group n = 26), analgesia was provided with fentanyl 3,89±2.03 μg/kg/h. In group 2 (n = 25), multimodal low-opioid general anesthesia was performed with fentanyl 1.76±1.2 μg/kg/h and IV lidocaine 1.5 mg/kg/h and subanesthetic doses of ketamine. In group 3 (n = 29), multimodal anesthesia with low opioids was performed with fentanyl 2.38±1.01 μg/kg/h in combination with dexmedetomidine 0.7 μg/kg/h. The efficacy of antinociceptive protection was assessed by the dynamics of changes in stress hormone levels, hemodynamic parameters, and blood glucose concentration. Results. The mean total dose of fentanyl used throughout the anesthetic period was: 369,23±83,75 μg in group 1, 216,0±47,26 μg in group 2, and 272,41±58,14 μg in group 3 (p < 0.001). Mean cortisol levels were significantly different before and after surgery in groups 1 and 2: 371,0±161,61 nmol/l vs 562,72±226,87 nmol/l (p < 0.01) and 531,08±218,02 nmol/l vs 831,33±235,32 nmol/l (p < 0.01), respectively. In group 3, we did not detect any statistical difference: 393,51±134,69 nmol/l and 436,37±188,09 nmol/l, respectively (p > 0.05). The mean level of adrenocorticotropic hormone increased significantly after surgery in all studied groups: 111.86% in group 1 (p < 0.01), 122.02% (p < 0.01) in group 2 and 78.59% (p < 0.01) in group 3. Blood glucose levels in the postoperative (p/o) period did not exceed 6,16±1,67 mmol/l (p > 0.05) in all groups. Hemodynamic parameters and BIS, which were maintained within 44±6.4%, indicated the adequacy of anesthesia and analgesia in the study groups. In group 1, 8 of 26 patients required additional analgesia with opioids during the p/o period (pain intensity on the VAS scale exceeded 4 points). In group 2 and group 3, 4 patients each required opioid analgesia, 16% and 15.38%, respectively. The next day after surgery, all patients were mobilized (sitting in bed, walking). Markers of renal function were also within normal range in all patients. Conclusion. The use of low-opioid multimodal anesthesia with IV lidocaine or dexmedetomidine during laparoscopic renal surgery provides an adequate anesthetic/antinociceptive effect. The use of dexmedetomidine in multimodal general anesthesia provides the greatest antinociceptive protection and reduces the stress response to surgery.

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Kidney Supportive Care

Kaur,

Figuracion

2024

Kidney Disease in the Elderly

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Opioid Management in CKD

Cited by 9 publications

References 50 publications

Comparison of different sustained‐release opioids and acute respiratory conditions in patients with cancer and chronic kidney disease

Comparison of different sustained‐release opioids and acute respiratory conditions in patients with cancer and chronic kidney disease

Аssessment of the antinociceptive efficacy of varieties of multimodal low-opioid general anesthesia during laparoscopic renal surgery

Kidney Supportive Care

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