Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • ASN Meeting Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
    • Reprint Information
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Reprint Information
    • Subscriptions
    • Feedback
  • ASN Kidney News
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Advertisement
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • ASN Meeting Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
    • Reprint Information
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Reprint Information
    • Subscriptions
    • Feedback
  • ASN Kidney News
  • Visit ASN on Facebook
  • Follow CJASN on Twitter
  • CJASN RSS
  • Community Forum
Patient Voice
Open Access

Appropriate Use of Opioids in Patients with Kidney Diseases

David M. White
CJASN May 2018, 13 (5) 675-676; DOI: https://doi.org/10.2215/CJN.03540318
David M. White
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • View PDF
Loading
  • Accidental Falls
  • Analgesics
  • Analgesics, Opioid
  • Confounding Factors (Epidemiology)
  • dialysis
  • Female
  • Fractures, Bone
  • Health Personnel
  • hemodialysis
  • Humans
  • Kidney Diseases
  • nephrology
  • Opioid-Related Disorders
  • Pain Management
  • Prescriptions
  • quality of life
  • renal dialysis

In this issue of the Clinical Journal of the American Society of Nephrology, Ishida et al. report on an investigation using data from the US Renal Data System to investigate the effects of opioids on patients on hemodialysis (1). The timely findings of Dr. Julie Ishida and her colleagues regarding the effects of opioid use on patients on hemodialysis confirm a need for more nephrology-related pain management research. Dr. Ishida’s team concluded that there is a correlation between higher opioid dosages and the likelihood of a patient on hemodialysis suffering an adverse event, and that painkillers not normally prescribed for patients on hemodialysis may create an even higher risk of falls, fractures, and altered mental states (1). The authors noted several study limitations and caveats, including the unexplained clinical context behind each prescription and not knowing when the prescribed opioids were taken or if they were administered properly (1). The ready availability of painkillers from sources other than health care providers presents an additional confounding variable.

Three months after a successful arteriovenous fistula surgery, a sharp large-gauge needle was inserted into my fully matured fistula for the first time, and over the next 6 years that procedure was repeated over 1000 times. Bracing myself for those painful “sticks” became part of my dialysis ritual. Remarkably, I never once asked if those brief moments of agony could be alleviated, and no one ever mentioned the possibility of trying something that could make getting “put on” the machine less painful. Looking back, I am astounded that neither I nor any member of my care team ever brought up the subject. Why didn’t that conversation ever take place?

Pain is one of the most commonly reported symptoms by patients on hemodialysis (1). The relationship between dialysis and pain can be as straightforward as a needle stick, but is much more often a murky matrix of biology and the people and equipment involved. Everyone’s path to dialysis is different (the permutations are staggering) and the fact that each session can range from being a pleasant visit to an inconvenience to a traumatic experience or worse adds an additional level of complexity. Pain management protocols can range from precise methodologies to “one-size-fits-all,” to woefully dismissive approaches—a sure recipe for patient harm.

Dr. Ishida’s team recommends more “research and strategies to predict and mitigate the risks of opioid use in patients on hemodialysis” (1). To this end, a cohesive, holistic strategy for treating pain management in the hemodialysis patient population should be developed and formally adopted, building upon points four and five of the US Department of Health and Human Services’ recently enacted Five-Point Strategy to Combat the Opioid Crisis (2) (point four, support cutting edge research on pain and addiction; and point five, advance better practices for pain management), with the goal of balancing pain management with patient and care partner values and preferences. I suggest convening a blue-ribbon task force to create a strategy that integrates the concepts of patient engagement, patient-centered care, and shared decision-making with a value-based payment model that measures and rewards clinical improvements and patient satisfaction.

Pain management is an essential component of care planning for patients on hemodialysis, and I commend the authors for calling attention to this topic. Just as certain immunosuppressants prevent organ rejection while simultaneously damaging the graft, this article illustrates that opioids can both cause and alleviate mental and/or physical anguish. Far too often, we just treat pain without talking about it, and this flies in the face of patient engagement. Patients on hemodialysis and their care partners should be encouraged to engage in patient-centered pain management discussions with their care teams. Patient experiences cover a broad range of perspectives and provide informed opinions, and we should be equal partners in the care planning process. Patients have a right to have clinicians ask them about their experience of pain and be partners in the discussion about the risk and benefits of various approaches to treating pain.

Patients and care partners are the most underutilized resource in health care. Health care providers have a duty to inform us whenever a medical decision introduces additional risks. Considering the annual increase in the global ESKD population, we desperately need more pain management research as it relates directly to both clinical care planning and the quality of life for hundreds of thousands of patients on hemodialysis. Opioids should be the last pain management option, not the first.

Disclosures

D.M.W. received an honorarium in 2018 from CareDx. D.M.W.’s three great-grandchildren own Amgen stock. D.M.W. reviewed a Kidney Health Initiative project entitled “Understanding and Overcoming the Challenges to Involving Patients with Kidney Disease in Cardiovascular Trials.” Dr. Julie Ishida is a workgroup co-chair of the project. D.M.W. serves on the American Association of Kidney Patients Board of Directors, the Kidney Health Initiative Board of Directors, and the Veterans Transplantation Association Board of Directors, is Chair of the Kidney Health Initiative Patient and Family Partnership Council, and is co-chair of the Patient-Centered Outcomes Research Institute Advisory Panel on Patient Engagement.

Footnotes

  • Published online ahead of print. Publication date available at www.cjasn.org.

  • See related article, “Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients,” on pages 746–753.

  • Copyright © 2018 by the American Society of Nephrology

References

  1. ↵
    1. Ishida JH,
    2. McCulloch CE,
    3. Steinman MA,
    4. Grimes BA,
    5. Johansen KL
    : Opioid analgesics and adverse outcomes among hemodialysis patients. Clin J Am Soc Nephrol 13: 746–753, 2018
    OpenUrlAbstract/FREE Full Text
    1. Jones CM,
    2. Singh VM
    : Advancing the practice of pain management under the HHS opioid strategy. Available at: https://www.hhs.gov/blog/2017/11/01/advancing-the-practice-of-pain-management-under-the-hhs-opioid-strategy.html. Accessed March 16, 2018
PreviousNext
Back to top

In this issue

Clinical Journal of the American Society of Nephrology: 13 (5)
Clinical Journal of the American Society of Nephrology
Vol. 13, Issue 5
May 07, 2018
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
View Selected Citations (0)
Print
Download PDF
Sign up for Alerts
Email Article
Thank you for your help in sharing the high-quality science in CJASN.
Enter multiple addresses on separate lines or separate them with commas.
Appropriate Use of Opioids in Patients with Kidney Diseases
(Your Name) has sent you a message from American Society of Nephrology
(Your Name) thought you would like to see the American Society of Nephrology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Appropriate Use of Opioids in Patients with Kidney Diseases
David M. White
CJASN May 2018, 13 (5) 675-676; DOI: 10.2215/CJN.03540318

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Request Permissions
Share
Appropriate Use of Opioids in Patients with Kidney Diseases
David M. White
CJASN May 2018, 13 (5) 675-676; DOI: 10.2215/CJN.03540318
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Disclosures
    • Footnotes
    • References
  • Info & Metrics
  • View PDF

More in this TOC Section

  • Patients with Kidney Disease: Ready to Use Smartphones for Health Care Delivery?
  • Fatigue While Undergoing Long-Term Hemodialysis
  • Improving the Evaluation Process for Potential Living Kidney Donor Candidates
Show more Patient Voice

Cited By...

  • No citing articles found.
  • Google Scholar

Similar Articles

Related Articles

  • Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients
  • PubMed
  • Google Scholar

Keywords

  • Accidental Falls
  • Analgesics
  • Analgesics, Opioid
  • Confounding Factors (Epidemiology)
  • dialysis
  • Female
  • Fractures, Bone
  • Health Personnel
  • hemodialysis
  • Humans
  • kidney diseases
  • nephrology
  • Opioid-Related Disorders
  • pain management
  • Prescriptions
  • quality of life
  • renal dialysis

Articles

  • Current Issue
  • Early Access
  • Subject Collections
  • Article Archive
  • ASN Meeting Abstracts

Information for Authors

  • Submit a Manuscript
  • Trainee of the Year
  • Author Resources
  • ASN Journal Policies
  • Reuse/Reprint Policy

About

  • CJASN
  • ASN
  • ASN Journals
  • ASN Kidney News

Journal Information

  • About CJASN
  • CJASN Email Alerts
  • CJASN Key Impact Information
  • CJASN Podcasts
  • CJASN RSS Feeds
  • Editorial Board

More Information

  • Advertise
  • ASN Podcasts
  • ASN Publications
  • Become an ASN Member
  • Feedback
  • Follow on Twitter
  • Password/Email Address Changes
  • Subscribe

© 2021 American Society of Nephrology

Print ISSN - 1555-9041 Online ISSN - 1555-905X

Powered by HighWire