Pain Management in Pediatric Chronic Kidney Disease
#MMPMID29970975
Reis A
; Luecke C
; Davis TK
; Kakajiwala A
J Pediatr Pharmacol Ther
2018[May]; 23
(3
): 192-202
PMID29970975
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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.
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