Nair Nikhil, Guedes Murilo, Ghose Shaarav, Kumar Rohan, Doshi Kush, Pinho Natalia Alencar-de, Tu Charlotte, Bieber Brian, Combe Christian, Reichel Helmut, Argyropoulos Christos, Pecoits-Filho Roberto, Raina Rupesh
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
Hemodial Int. 2025 Jul 23. doi: 10.1111/hdi.70013.
Chronic pain is common in patients with chronic kidney disease (CKD), yet pain management in non-dialysis-dependent CKD (NDD-CKD) is underexplored. Inappropriate analgesic use poses significant risks in this population.
To evaluate patterns of analgesic use-specifically opioids and NSAIDs-and associated clinical characteristics in patients with NDD-CKD.
A systematic review was conducted following PRISMA 2020 guidelines. Databases including PubMed and ClinicalTrials.gov were searched in December 2024 using MeSH terms related to CKD, analgesics, opioids, and NSAIDs. Inclusion criteria targeted NDD-CKD patients with reported analgesic use. Data extraction and risk of bias assessments were performed independently by two reviewers.
Nine studies encompassing 3,674,959 patients were included. Opioid use was reported in 324,111 patients (22.8%), while NSAIDs were used in 1,095,052 (77.1%). Opioid use increased with CKD severity and pain intensity, but was associated with higher mortality, especially in frail or comorbid patients. NSAID use was prevalent in early-stage CKD and associated with nephrotoxic risk and may occur without clinician oversight. Regional variation and inconsistent prescribing practices were noted. No study directly compared opioid vs. NSAID outcomes.
Analgesic use in NDD-CKD is widespread and varies by region, CKD stage, and pain severity. Inadequate pain control is common. Standardized guidelines tailored to CKD patients are urgently needed to optimize pain management while minimizing harm.
慢性疼痛在慢性肾脏病（CKD）患者中很常见，但非透析依赖型CKD（NDD-CKD）患者的疼痛管理尚未得到充分研究。在这一人群中，不适当使用镇痛药会带来重大风险。
评估NDD-CKD患者的镇痛药使用模式，特别是阿片类药物和非甾体抗炎药（NSAIDs），以及相关的临床特征。
按照PRISMA 2020指南进行系统评价。2024年12月，使用与CKD、镇痛药、阿片类药物和NSAIDs相关的医学主题词（MeSH）在PubMed和ClinicalTrials.gov等数据库中进行检索。纳入标准针对报告使用过镇痛药的NDD-CKD患者。由两名 reviewers 独立进行数据提取和偏倚风险评估。
纳入了9项研究，涉及3,674,959名患者。324,111名患者（22.8%）报告使用了阿片类药物，而1,095,052名患者（77.1%）使用了NSAIDs。阿片类药物的使用随着CKD严重程度和疼痛强度的增加而增加，但与较高的死亡率相关，尤其是在体弱或合并症患者中。NSAIDs的使用在CKD早期很普遍，与肾毒性风险相关，并且可能在没有临床医生监督的情况下发生。注意到了地区差异和不一致的处方做法。没有研究直接比较阿片类药物与NSAIDs的疗效。
NDD-CKD患者中镇痛药的使用很普遍，并且因地区、CKD分期和疼痛严重程度而异。疼痛控制不足很常见。迫切需要针对CKD患者制定标准化指南，以优化疼痛管理，同时将危害降至最低。
