Clinical Pharmacology Considerations in Pain Management in Patients with Advanced Kidney Failure

Clin J Am Soc Nephrol. 2019 Jun 7;14(6):917-931. doi: 10.2215/CJN.05180418. Epub 2019 Mar 4.


Pain is common and poorly managed in patients with advanced CKD, likely due to both under and over prescription of appropriate analgesics. Poorly managed pain contributes to patients' poor quality of life and excessive health care use. There is tremendous variability within and between countries in prescribing patterns of analgesics, suggesting that factors other than patient characteristics account for these differences. This article discusses the pharmacologic management of acute and chronic pain in patients with advanced CKD, and the role analgesics, including opioids, play in the overall approach to pain management.

Keywords: Analgesics, Opioid; Chronic Pain; NSAIDs; Pain Management; Pharmacology, Clinical; Prescriptions; Renal Insufficiency, Chronic; analgesics; chronic kidney disease; opioids; pain; quality of life.

MeSH terms

  • Acetaminophen / therapeutic use
  • Acute Pain / drug therapy
  • Analgesics, Non-Narcotic / therapeutic use*
  • Analgesics, Opioid / metabolism
  • Analgesics, Opioid / therapeutic use*
  • Carbamazepine / therapeutic use
  • Chronic Pain / drug therapy
  • Gabapentin / therapeutic use
  • Humans
  • Ketamine / therapeutic use
  • Kidney Failure, Chronic / physiopathology*
  • Kidney Failure, Chronic / therapy
  • Neuralgia / drug therapy*
  • Nociceptive Pain / drug therapy*
  • Pain Management / methods
  • Renal Dialysis


  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Carbamazepine
  • Acetaminophen
  • Ketamine
  • Gabapentin