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Pain Management in Patients with Renal Impairment

Abstract

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.

Keywords

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 

Abbreviations

ADH

Antidiuretic hormone

CHF

Congestive heart failure

Cmax

Concentration max/peak concentration

CNS

Central nervous system

CrCl

Creatinine clearance

CSF

Cerebral spinal fluid

ESRD

End stage renal disease

GFR

Glomerular filtration rate

HD

Hemodialysis

IBW

Ideal body weight

M6G

Morphine-6-glucuronide

NSAID

Nonsteroidal anti-inflammatory drugs

PD

Peritoneal dialysis

SIADH

Syndrome of inappropriate antidiuretic hormone secretion

SNRI

Serotonin–norepinephrine reuptake inhibitors

SSRIs

Selective serotonin reuptake inhibitors

t1/2

Half-life

TCA

Tricyclic antidepressants

Vd

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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