Pain Management in Patients with Renal Impairment


Patients with chronic kidney disease must be given extra consideration when prescribing medications for symptom control as many medications are excreted through the renal system. Renal function, or glomerular filtration rate, should be estimated by calculating creatinine clearance using the Cockcroft–Gault equation. Patients with CKD are often excluded from trials, and for many medications specific studies regarding dosing and metabolism in this population are lacking. Therefore, it is important to note recommendations, use caution when starting medications, and follow patients closely.


Chronic kidney disease (CKD) Clearance Creatinine clearance (CrCl) Cockcroft–Gault Dialysis End stage renal disease (ESRD) Glomerular filtration rate (GFR) Mild renal impairment Moderate renal impairment Renal dosing Renal insufficiency Severe renal impairment 



Antidiuretic hormone


Congestive heart failure


Concentration max/peak concentration


Central nervous system


Creatinine clearance


Cerebral spinal fluid


End stage renal disease


Glomerular filtration rate




Ideal body weight




Nonsteroidal anti-inflammatory drugs


Peritoneal dialysis


Syndrome of inappropriate antidiuretic hormone secretion


Serotonin–norepinephrine reuptake inhibitors


Selective serotonin reuptake inhibitors




Tricyclic antidepressants


Volume of distribution


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© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Medicine, Division of Kidney Diseases and HypertensionHofstra North Shore-LIJ School of MedicineGreat NeckUSA

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