Analgesia in patients with ESRD: a review of available evidence

Am J Kidney Dis. 2003 Aug;42(2):217-28. doi: 10.1016/s0272-6386(03)00645-0.


Moderate to severe pain frequently accompanies chronic diseases in general and end-stage renal disease (ESRD) in particular. Several analgesic agents and associated metabolites show altered pharmacokinetics in the presence of reduced glomerular filtration rate. Drug-related side effects may exacerbate symptoms frequently observed in persons with chronic kidney disease (CKD; eg, fatigue, nausea, vomiting, and constipation) or those often attributed to hemodialysis therapy (eg, orthostatic hypotension and impaired cognition). Persons with advanced CKD and ESRD are at increased risk for adverse effects of analgesic agents because of enhanced drug sensitivity, comorbid conditions, and concurrent medication use. Dose adjustment and avoidance of certain analgesics may be required in patients with advanced CKD and ESRD. We review the available evidence on pharmacokinetics and adverse drug effects of various analgesic agents commonly used in patients with advanced CKD and ESRD. Determining an optimal approach to the control of pain in patients with advanced CKD and ESRD will require additional research.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Acetaminophen / therapeutic use
  • Aged
  • Analgesia / methods*
  • Analgesia, Patient-Controlled
  • Analgesics / adverse effects
  • Analgesics / classification
  • Analgesics / therapeutic use*
  • Analgesics, Opioid / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Anticonvulsants / therapeutic use
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Humans
  • Kidney Failure, Chronic / complications*
  • Pain / drug therapy*
  • Pain / etiology
  • Terminal Care


  • Analgesics
  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticonvulsants
  • Antidepressive Agents, Tricyclic
  • Acetaminophen