Abstract:Approximately 50% of patients with chronic kidney disease (CKD) have chronic pain. This pain is often severe and associated with poor quality of life, contributing to increased morbidity and mortality. Given limited evidence of nonpharmacological pain treatments in CKD, opioids are frequently prescribed for pain relief. However, opioids, especially long-term opioids, need to be carefully prescribed to patients with CKD. Kidney disease alters drug clearance and increases the risk of metabolite accumulation, and opioid use in CKD has been associated with significant adverse events, including increased hospitalizations and mortality. For patients on opioids with CKD, pharmacologic evidence suggests that some opioids are safer for use in CKD than others based on their metabolic pathway. For example, morphine is not recommended in CKD because the metabolite, morphine-6-glucuronide, is renally excreted and in renal failure can accumulate and cause significant respiratory depression.