Reis Amanda, Luecke Caitlyn, Davis Thomas Keefe, Kakajiwala Aadil
J Pediatr Pharmacol Ther. 2018 May-Jun;23(3):192-202. doi: 10.5863/1551-6776-23.3.192.
Pain is a common problem in children with chronic kidney disease (CKD); however, limited data exist regarding its management. Although most pain is managed pharmacologically, in some instances non-pharmacologic management can aid in safely ameliorating discomfort. Because of the accumulation of toxic metabolites, many common pain medications have adverse effects on kidney function or altered pharmacokinetics in the setting of CKD. Decreased clearance impacts safe dosing of analgesics. The pain management of patients on renal replacement therapy requires an understanding of drug clearance due to the different modalities of dialysis. This educational review highlights pain medications that are safe, albeit often with adjusted dosing, as well as drugs best avoided in the management of pediatric kidney disease. Acetaminophen should be used as a first-line therapy for pain management in children with CKD. Opioids may be added to control moderate to severe pain. Although data are currently lacking, buprenorphine holds promise as a potentially useful drug for the treatment of pain in pediatric patients with CKD. The addition of adjuvant pain medications and non-pharmacologic therapies maybe also be helpful. Despite these options, pain often remains difficult to treat in children with CKD.
疼痛是慢性肾脏病（CKD）患儿的常见问题；然而，关于其管理的数据有限。尽管大多数疼痛通过药物治疗，但在某些情况下，非药物管理有助于安全减轻不适。由于有毒代谢产物的积累，许多常用的止痛药物对肾功能有不良影响，或在CKD情况下药代动力学发生改变。清除率降低会影响镇痛药的安全给药剂量。接受肾脏替代治疗的患者的疼痛管理需要了解由于不同透析方式导致的药物清除情况。这篇教育综述重点介绍了尽管通常需要调整剂量但仍安全的止痛药物，以及在小儿肾脏疾病管理中最好避免使用的药物。对乙酰氨基酚应用作CKD患儿疼痛管理的一线治疗药物。可加用阿片类药物控制中度至重度疼痛。尽管目前缺乏相关数据，但丁丙诺啡有望成为治疗CKD小儿患者疼痛的潜在有用药物。加用辅助性止痛药物和非药物治疗可能也有帮助。尽管有这些选择，但CKD患儿的疼痛通常仍难以治疗。
