2017 update on pain management in patients with chronic kidney disease

Pham, Phuong Chi T.; Khaing, Kathy; Sievers, Theodore M.; Pham, Phuong Mai T.; Miller, Jeffrey M.; Pham, Son V.; Pham, Phuong Anh; Pham, Phuong Thu

doi:10.1093/ckj/sfx080

Cited by 113 publications

(126 citation statements)

References 56 publications

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“…Though while a degree of attentiveness was suggested, there seems to be a variance of recommendations in those with an eGFR <45 mL/min. This is unsurprising given the lack of data to support clinical decision making (Pham et al, ) and warrants further research for guidance.…”

Section: Discussionmentioning

confidence: 99%

“…While it is likely topical NSAIDs are a safer option than oral NSAIDs for prevention of renovascular injury, especially in those with chronic kidney disease (CKD), there is a paucity of data to support this (Pham et al, ). Guidelines are almost non‐existent, the 2012 Kidney Disease improving Global Outcomes guidelines (KDIGO, ) suggest discontinuation of all NSAIDs in those with an estimated Glomerular Filtration Rate (eGFR) <30 mL/min (topical NSAIDs are not specifically mentioned), Pham et al () in their recommendations of pain management in CKD, suggest caution in those with an eGFR <30 mL/min.…”

Section: Introductionmentioning

confidence: 99%

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Survey of Australasian Renal and Rheumatology Specialists investigating topical NSAID use and adverse renal outcomes

Terrill

Soden

Srivastava

2020

Musculoskeletal Care

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Introduction:A survey investigated physician reported use, prescribing practices and adverse renal events of topical NSAIDs.Method: This survey was sent to members of the Australian Rheumatology Association and the Australian and New Zealand Society of Nephrology.Results: Sixty physicians responded, 55% (n = 33) were nephrologists; 45% (n = 27) rheumatologists.Nearly all (n = 56, 93.3%) had managed at least one patient using topical NSAIDs, including those with an eGFR <45 mL/min (n = 55, 91.7%). Concern was expressed that patients may use topical NSAIDs without the physician's knowledge. The majority (n = 40, 66.6%) have prescribed (or recommended) a topical NSAID, slightly less in patients with a reduced eGFR <45 mL/min (n = 36, 60.0%). Participants would advise topical NSAIDs for osteoarthritis and musculoskeletal pain, though be mindful to monitor the renal function and blood pressure. There was a variance in comments in advising use in CKD (eGFR <45 mL/min) from avoidance in those with an eGFR <30 mL/min to minimal concern. Most respondents (n = 55, 91.7%) had not encountered an acute kidney injury (AKI) suspected from topical NSAID use. Of the five that did, three were thought to be an adverse renovascular event and two were uncertain.All patients had an eGFR <45 mL/min, all had recovery f their renal function with NSAID cessation. Discussion: Patients commonly use topical NSAIDs, often without the physician's knowledge. Most respondents would recommend their use in osteoarthritis and musculoskeletal pain, though with caution in CKD. While an AKI is uncommon due to topical NSAIDs, it may occur, especially in those with CKD. Abstract 2-012: Defining the impact of topical non-steroidal anti-inflammatory drugs on renal function, a survey of Australasian Renal and Rheumatology Specialists. Poster Abstracts. Int J Rheum Dis: 22:40-226.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Survey of Australasian Renal and Rheumatology Specialists investigating topical NSAID use and adverse renal outcomes

Terrill

Soden

Srivastava

2020

Musculoskeletal Care

View full text Add to dashboard Cite

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“…Another consideration is that fentanyl is a more lipophilic agent and distributes into fatty tissues, giving it a longer half‐life in patients with large fat stores 12 . Neonates are also at particularly high risk for respiratory depression due to immature hepatic enzymes and decreased hypoxic respiratory drive 13 . Pain control in the pediatric population is a perplexing patient‐specific problem, and management has been further complicated due to the national shortages of many of the IV opioid pain management options…”

Section: Discussionmentioning

confidence: 99%

“…12 Neonates are also at particularly high risk for respiratory depression due to immature hepatic enzymes and decreased hypoxic respiratory drive. 13 Pain control in the pediatric population is a perplexing patient-specific problem, and management has been further complicated due to the national shortages of many of the IV opioid pain management options Despite opioid stewardship efforts at our hospital, no difference in the amount of pain medication, quantified as milligrams of morphine equivalents per kilogram per day, was seen between 2017 and 2018.…”

Section: Diagnoses Categorized As Other Includes Double Inlet Left Vementioning

confidence: 99%

The impact of intravenous opioid shortages on postoperative pain control in a pediatric cardiac intensive care unit

et al. 2020

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Background The national supply of intravenous pain medications has been restricted since 2018 due to shortages. In late 2017, the ongoing shortages combined with the increased demand for alternative formulations resulted in interruptions in the supply of medications. The cascading effect of interruptions in supply caused hospitals to implement restrictive measures to extend the availability of these medications. This study aims to evaluate differences in pain control in postoperative cardiac patients due to intravenous opioid shortage at a standalone pediatric hospital. Method A retrospective chart review of postoperative patients in the cardiac intensive care unit at Children's National Hospital was conducted from January to September 2017 and 2018. The objective of this study is to determine if a difference in postoperative pain scores in the period before and during the national intravenous opioid shortage exists, analyzed by differences in Face, Legs, Activity, Cry, Consolability (FLACC) scores. Results No differences were found in mean FLACC scores for the 140 patients who were evaluated. Patients in 2017 reported faster decline of pain symptoms compared with those in 2018. No differences in baseline characteristics or secondary outcomes were noted. Conclusion Pain management was better controlled immediately postoperatively in 2018 compared with 2017, but the pain was better controlled for the duration of the postoperative period in 2017.

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“…3 An estimated 60% to 70% of patients with chronic kidney disease and ESRD have chronic pain. 6 The stress from living in homeless shelters, poor sleeping conditions, inability to afford medications, and missed appointments exacerbate pain in patients who are homeless, which can lead to reliance on street drugs and an increased risk of overdose. 7 The myriad management challenges and logistical barriers lead to missed dialysis sessions and promote heavy reliance on emergency-only dialysis.…”

mentioning

confidence: 99%

Dialysis for Patients With End-stage Renal Disease Who Are Homeless

2018

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End-stage renal disease (ESRD) affects more than 700 000 individuals in the United States and accounts for $33 billion in annual Medicare spending. 1 Since 1973, the Medicare program has provided health coverage for most individuals with ESRD regardless of their age. About 34% of people with newly diagnosed ESRD live in areas where more than 1 in 5 households are below the federal poverty level. 2 Although the prevalence of homelessness among patients with ESRD is unknown, such patients would benefit from safe and stable housing. Homelessness imposes substantial barriers to good medical care. 3 We highlight the challenges faced by patients with ESRD who are homeless, recommend measures to determine the prevalence and outcomes of homelessness among Medicare beneficiaries with ESRD, and propose approaches, including a federal demonstration project, to potentially improve outcomes through supportive housing.Providing housing to people with medically complex diseases has the potential to improve their health and decrease spending on acute care. 4,5 Housing programs targeting individuals with HIV infection, mental illness, and substance use disorders have expanded throughout the United States. Examples include programs that provide housing vouchers, short-term rental assistance, transitional housing, and permanent supportive housing that combines affordable housing with medical, mental health, and social services. 4,5 Scatteredsite permanent supportive housing pairs single apartments in existing buildings with multidisciplinary case management. Single-site permanent supportive housing consists of entire buildings dedicated to specific groups of people and offers multidisciplinary services on-site. Analyses of permanent supportive housing programs have shown reductions in hospital admissions, increased engagement in care, improvements in overall survival, and substantial reductions in acute care spending. 4,5 We are unaware, however, of any such programs in the United States for patients with ESRD. Providing supportive housing with appropriate multidisciplinary services to patients with ESRD who are homeless would be an important advance.Patients who receive dialysis have complex medical regimens and challenging dietary restrictions. Transportation to and from dialysis centers and coordination with other outpatient appointments are common obstacles. 3 An estimated 60% to 70% of patients with chronic kidney disease and ESRD have chronic pain. 6 The stress from living in homeless shelters, poor sleeping conditions, inability to afford medications, and missed appointments exacerbate pain in patients who are

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2017 update on pain management in patients with chronic kidney disease

Cited by 113 publications

References 56 publications

Survey of Australasian Renal and Rheumatology Specialists investigating topical NSAID use and adverse renal outcomes

Survey of Australasian Renal and Rheumatology Specialists investigating topical NSAID use and adverse renal outcomes

The impact of intravenous opioid shortages on postoperative pain control in a pediatric cardiac intensive care unit

Dialysis for Patients With End-stage Renal Disease Who Are Homeless

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