Achieving effective pain relief in patients with chronic kidney disease: a review of analgesics in renal failure

Increasing evidence in literature shows that chronic pain is a common and disabling symptom in patients with chronic kidney disease (CKD). As the dialysis population all over the world ages and experiences multiple co-morbidities, nephrologists are increasingly faced with the complex task of addressing them effectively to sustain a reasonable health-related quality of life for their patients. The overall symptom burden of these patients is high and is similar to the end-of life cancer population. The complex pharmacokinetics of opioid analgesics in patients with pre-existing renal disease as well as physician unfamiliarity with the use of these drugs is a barrier to providing effective pain relief. This review deals with approaches to the management of pain in patients with CKD.