Use of Opioid in Dialysis Patients: Effects and Controversies

This article discusses the use of opioids for pain management in dialysis patients. It explores the risks and benefits of opioid use, including addiction, overdose, and adverse effects. The article also suggests that opioids should be used as a last resort for pain management and that careful monitoring and dosage reduction may be necessary.

Use of Opioid in dialysis patients
Kidney disease is quite common nowadays and the association of pain is very much
concerning among the people who are suffering from chronic kidney disease. When a patient
lose 85-90% of kidney function, dialysis is required at that stage (Kimmel et al. 2017). That
time, dialysis keeps the body balanced by removing salt, waste as well as extra water to
prevent them from building up inside the body. It also helps to maintain the level of certain
chemicals in the blood to control the pressure of blood in the human being. In most of the
cases kidney failure is permanent but in some exceptional cases kidney failure is cured after
some acute treatment. However, in both the cases, until the kidney begins to function
properly, dialysis is required to maintain the balance and even it can be continued for the rest
of the life also (Olivo et al. 2015). Pain and dialysis are interrelated and one of the major after
effect of dialysis is pain. Dialysis is painful and in order to manage the pain, several drugs
and medicines are used among the patients and one of them is Opioid.
Investigators found from many studies that almost two-third of the dialysis patients
received at least one opioid prescription per year during their treatment process and among
them 20% received the repeated prescription of opioid (Kimmel et al. 2017). According to a
news release journal, more than 25% of patients who were given opioid prescription received
higher than recommended doses (Kimmel et al. 2017). However, many studies revealed that
use of opioids leads to addiction and overdose of it is also a leading cause of increased deaths
among the dialysis patients (Kimmel et al. 2017). The patients of chronic kidney disease
mainly suffer from excessive pain due to various causes. Sometimes the pain occurs due to
nerve damage. Since, mid 1990s the use of opioids has been increased in the United States
(Kimmel et al. 2017). 50% long term dialysis patients reported that they suffer from
excessive chronic pain and 75% of them stated their pain management is inadequate and
among the sufferers 55% described that their pain sometimes last up to 24 hours which is

extremely unbearable for them (Atkinson, Fudin and Bettinger 2014). Unfortunately, there is
no any particular medication to prevent the pain but it can be managed by providing some
pain killers with the action of sleeping pills. Opioids block the pain message signal to the
brain so the patient cannot feel it for some time and when the patient gets some relief from
pain it helps them to sleep for hours without having any pain. However, sometimes patients
are more likely to consume it going beyond the prescribed solutions and overdose of opioids
can cause serious health issues as it creates addiction among the patients and even in some
cases it also leads to the death of the patient. Excessive use of it can hamper the proper
functioning of the nervous system which in turn produces adverse effects on health such as
the patient might become drowsy, uncoordinated, and inattentive and these are the leading
cause of fall risk and at the same time it is responsible for the dysfunction of brain among the
patients (Silverman et al. 2017).
In order to find the effects of opioids, various studies have been organized. In the year
2011, U.S. Renal Data System (USRDS) organized a study on the hemo-dialysis patient who
received opioids and among them 17% stated that they experienced at least one episode of
altered mental status fractures or falls and altered mental status was the highest incidence of
11% (Williams 2018). Sometimes opioids are not preferred to recommend in the renal failure
as it cause seizures among the patients. Some opioids have been reported to cause profound
toxicity among the patients. However, the most likely to die from opioid related causes are
the addicted patients for whom it becomes an overdose because there is a strong correlation
between overdose and adverse effects.
Opioids are basically morphins and some similar drugs are derived from opium. If in
chronic problem like kidney disease and dialysis, it is used regularly then it will cause
dependence and addiction for the drug and at the same time it will also develop the drug
tolerance among the patients and after a period of regular use, it will become a failure in pain

management too. Some dose of medicine will not be helpful to relieve the pain and patient
will look forward to the overdose of it which in turn will lead to the death of the patient.
When doctors prescribe the medicine in the pain management of dialysis, at the beginning
they get relief but addiction occurs and patients will find difficulty in stopping the use of this
drug. As a result they will also face depression, poor appetite, constipation and several other
serious side effects of using excessive opioids in managing pain (Pham et al. 2017).
However, many researchers said that pain management can be difficult in dialysis as people
suffer from severe pain due to this but use of opioids should not be the first option as a pain
management tool rather it should be applied as the last option when nothing is working
properly to manage the pain (White 2018). On the basis of calculated GFR value among the
dialysis patient, some authors recommended the dosage reduction of opioids. Before applying
opioids the doctors must consider the factor of caution of using it. However, some studies
related to this have also revealed that with careful monitoring of the doctors and limiting the
dosage, the drug can be used safely among the patient of dialysis. The normal and moderate
amount of opiods can be helpful in the pain management of dialysis and it adequately relieves
pain without having any adverse effect upon the health of the patient. It is the prime
responsibility of the doctors to specify the exact dose of opioids to be taken for pain
management in order to avoid adverse effects on health which can be extremely dangerous
(Cheatle 2015).
Sometimes pain management becomes very much difficult in some chronic diseases
like renal failure or dialysis. Opioids have a good recognition in managing the pain of patient.
However, controversy regarding the adverse effects of opioids is quite concerning before the
application but limiting the amount of dose cannot be dangerous for the patients. It should be
prescribed considering the health condition of the patient too. Patients should also be careful

about not exceeding the dosage restricted in the prescription. Educating the patient about the
side effects of this drug that can occur due to overdose is also necessary in this regard.

References
Atkinson, T.J., Fudin, J. and Bettinger, J.J., 2014. Dialysis, opioids, and pain management:
Where’s the evidence?. Letters To the Editor.
Cheatle, M.D., 2015. Prescription opioid misuse, abuse, morbidity, and mortality: balancing
effective pain management and safety. Pain Medicine, 16(suppl_1), pp.S3-S8.
https://www.pharmacytoday.org/article/S1042-0991(18)30954-X/fulltext
Kimmel, P.L., Fwu, C.W., Abbott, K.C., Eggers, A.W., Kline, P.P. and Eggers, P.W., 2017.
Opioid prescription, morbidity, and mortality in United States dialysis patients. Journal of the
American Society of Nephrology, 28(12), pp.3658-3670.
Olivo, R.E., Hensley, R.L., Lewis, J.B. and Saha, S., 2015. Opioid use in hemodialysis
patients. American Journal of Kidney Diseases, 66(6), pp.1103-1105.
Pham, P.C., Khaing, K., Sievers, T.M., Pham, P.M., Miller, J.M., Pham, S.V., Pham, P.A.
and Pham, P.T., 2017. 2017 update on pain management in patients with chronic kidney
disease. Clinical kidney journal, 10(5), pp.688-697.
Silverman, S., Raffa, R.B., Cataldo, M.J., Kwarcinski, M. and Ripa, S.R., 2017. Use of
immediate-release opioids as supplemental analgesia during management of moderate-to-
severe chronic pain with buprenorphine transdermal system. Journal of pain research, 10,
p.1255.
White, D.M., 2018. Appropriate Use of Opioids in Patients with Kidney Diseases. Clinical
Journal of the American Society of Nephrology, 13(5), pp.675-676.
Williams, R. A. (2018) Opioid treatment is risky in patients on hemodialysis. Pharmacy
Today [online]. July. Available from :