Palliation and Chronic Renal Failure: Opioid and Other Palliative Medications - Dosage Guidelines

Broadbent, Andrew; Khor, K; Heaney, April

doi:10.1179/096992603225002627

Cited by 31 publications

(11 citation statements)

References 10 publications

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“…Glycopyrrolate does not cross the blood‐brain barrier therefore does not cause sedation or delirium as hyoscinehydrobromide can (not recommended), thus it is first choice. Dose should be reduced to 50% of normal due to increased anti‐cholinergic side effects (e.g. 100–200 μg prn s/c q4h).…”

Section: Models Of Care – End Of Life Pathwaysmentioning

confidence: 99%

ANZSN Renal Supportive Care Guidelines 2013

Brown

Crail²,

Masterson

et al. 2013

Nephrology

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Section: Models Of Care – End Of Life Pathwaysmentioning

confidence: 99%

ANZSN Renal Supportive Care Guidelines 2013

Brown

Crail²,

Masterson

et al. 2013

Nephrology

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“…Moreover, the overuse of over-the-counter NSAIDs is particularly common in rheumatic conditions such as osteoarthritis [32] , thus further highlighting the importance of our results in CKD patients with such diseases who are already use prescription-only NSAIDs. Pain treatment in CKD still remains a primary issue for clinicians: while, in general, acetaminophen has been considered to be the safest non-narcotic analgesic in CKD patients it may be nephrotoxic with chronic use at high doses [33] . For treatment of moderate pain, the use of low-potency opioids is suggested unless CKD is very advanced [34] .…”

Section: Discussionmentioning

confidence: 99%

The Burden of Nephrotoxic Drug Prescriptions in Patients with Chronic Kidney Disease: A Retrospective Population-Based Study in Southern Italy

et al. 2014

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BackgroundThe use of nephrotoxic drugs can further worsening renal function in chronic kidney disease (CKD) patients. It is therefore imperative to explore prescribing practices that can negatively affect CKD patients.AimTo analyze the use of nephrotoxic drugs in CKD patients in a general population of Southern Italy during the years 2006–2011.MethodsThe general practice “Arianna” database contains data from 158,510 persons, registered with 123 general practitioners (GPs) of Caserta. CKD patients were identified searching: CKD-related ICD-9 CM codes among causes of hospitalization; CKD-relevant procedures undergone in hospital (e.g. dialysis); drug prescriptions issued for a CKD-related indication. A list of nephrotoxic drugs was compiled and validated by pharmacologists and nephrologists. The summary of product characteristics was used to classify drugs as ‘contraindicated’ or ‘to be used with caution’ in renal diseases. Frequency of nephrotoxic drug use, overall, by drug class and single compounds, by GPs within one year prior or after first CKD diagnosis and within one year after dialysis entry was calculated.ResultsOverall, 1,989 CKD patients and 112 dialysed patients were identified. Among CKD patients, 49.8% and 45.2% received at least one prescription for a contraindicated nephrotoxic drug within one year prior or after first CKD diagnosis, respectively. In detail, 1,119 CKD patients (56.3%) had at least one nonsteroidal anti-inflammatory drugs (NSAIDs) prescription between CKD diagnosis and end of follow-up. A large proportion of CKD patients (35.6%) were treated with NSAIDs for periods exceeding 90 days. Contraindicated nephrotoxic drugs were used commonly in CKD, with nimesulide (16.6%) and diclofenac (11.0%) being most frequently used.ConclusionsContraindicated nephrotoxic drugs were highly prescribed in CKD patients from a general population of Southern Italy. CKD diagnosis did not seem to reduce significantly the prescription of nephrotoxic drugs, which may increase the risk of preventable renal function deterioration.

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“…Minimizing the dose and frequency of acetaminophen intake should be considered, particularly for patients with a GFR <10 ml/min/ 1.73 m 2 (i.e. increase the dose interval from every 6 to 8 h) [ 56 ].…”

Section: Aspirin and Nonsteroidal Anti-inflammatory Drugsmentioning

confidence: 99%

Pain management in patients with chronic kidney disease

Pham¹,

Toscano²,

Pham³

et al. 2009

Clinical Kidney Journal

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Pain has been reported to be a common problem in the general population and end-stage renal disease (ESRD) patients. Although similar data for pre-ESRD patients are lacking, we recently reported that the prevalence of pain is also very high (>70%) among pre-ESRD patients at a Los Angeles County tertiary referral centre. The high prevalence of pain in the CKD population is particularly concerning because pain has been shown to be associated with poor quality of life. Of greater concern, poor quality of life, at least in dialysis patients, has been shown to be associated with poor survival. We herein discuss the pathophysiology of common pain conditions, review a commonly accepted approach to the management of pain in the general population, and discuss analgesic-induced renal complications and therapeutic issues specific for patients with reduced renal function.

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Palliation and Chronic Renal Failure: Opioid and Other Palliative Medications - Dosage Guidelines

Cited by 31 publications

References 10 publications

ANZSN Renal Supportive Care Guidelines 2013

ANZSN Renal Supportive Care Guidelines 2013

The Burden of Nephrotoxic Drug Prescriptions in Patients with Chronic Kidney Disease: A Retrospective Population-Based Study in Southern Italy

Pain management in patients with chronic kidney disease

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