Download PDF
Dtsch Med Wochenschr 2021; 146(15): 1009-1015
DOI: 10.1055/a-1388-9889
Übersicht

Schmerzmedikamente bei Nierenpatienten

Analgesic Drug Therapy in Kidney Patients
Peter Steffen
,
Frieder Keller
› Further Information
Also available at
    Permissions and Reprints

Für die Schmerztherapie bei Nierenkranken und Dialysepatienten sind besondere Kenntnisse nötig. Denn zunächst einmal können bestimmte Analgetika die Nieren schädigen. Hinzu kommt, dass die Dosierung von Koanalgetika wie Antikonvulsiva, Antidepressiva und Antipsychotika i. d. R. an die Nierenfunktion angepasst werden muss. Außerdem besteht bei einer Morphintherapie durch die Kumulationskinetik ein erhöhtes Risiko für eine Atemdepression.

Abstract

Analgesic drug therapy in kidney patients needs special expertise. Patients with kidney disease frequently have pain and they have chronic pain more than others. Some analgesic drugs have a nephrotoxic potential and co-analgesics such as anticonvulsive, antidepressive and antipsychotic drugs need a dose adjustment to kindey function. When treating kidney patients with morphine, the accumulation kinetics of the M6 glucuronide must be observed. Otherwise, the risk increases for respiratory depression.

Schlüsselwörter

Schmerztherapie - Nierenerkrankung - Dosisanpassung - Morphin - Dialyse

Key words

analgesic drugs - kidney disease - dose adjustment - morphine - dialysis


Publication History

Article published online:
03 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 James G, Nyman E, Fitz-Randolph M. et al. Characteristics, Symptom Severity, and Experiences of Patients Reporting Chronic Kidney Disease in the PatientsLikeMe Online Health Community: Retrospective and Qualitative Study. J Med Internet Res 2020; 22: e18548
    CrossrefPubMedGoogle Scholar
  • 2 Kotsis FK, Secula P, Schultheiss UT. et al Berichtete Einnahme von Medikamenten und Level von Medikamenten-Metaboliten im Urin in der German Chronic Kidney Disease (GCKD) Studie. Berlin: Deutsche Gesellschaft für Nephrologie DGfN Kongress; 2020 FV20
    PubMedGoogle Scholar
  • 3 Grekhov RA, Suleimanova GP, Trofimenko AS. et al. Psychosomatic Features, Compliance, and Complementary Therapies in Rheumatoid Arthritis. Curr Rheumatol Rev 2020; 16: 215-223
    CrossrefPubMedGoogle Scholar
  • 4 Edwards RR, Dworkin RH, Sullivan MD. et al. The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain. J Pain 2016; 17 (Suppl. 09) T70-T92
    CrossrefPubMedGoogle Scholar
  • 5 Thorell K, Midlöv P, Fastbom J. et al. Importance of potentially inappropriate medications, number of chronic conditions and medications for the risk of hospitalisation in elderly in Sweden: a case-control study. BMJ Open 2019; 9: e02947
    CrossrefPubMedGoogle Scholar
  • 6 Raouf M, Bettinger J, Wegrzyn EW. et al. Pharmacotherapeutic Management of Neuropathic Pain in End-Stage Renal Disease. Kidney Dis (Basel) 2020; 6: 157-167
    CrossrefPubMedGoogle Scholar
  • 7 Bausewein C, Simon ST, Pralong A. et al. Palliative Care of Adult Patients With Cancer. Dtsch Arztebl Int 2015; 112: 863-870
    PubMedGoogle Scholar
  • 8 Lötsch J, Dudziak R, Freynhagen R. et al. Fatal respiratory depression after multiple intravenous morphine injections. Clin Pharmacokinet 2006; 45: 1051-1060
    CrossrefPubMedGoogle Scholar
  • 9 Moist L. Pain management in a patient with kidney failure. Clin J Am Soc Nephrol 2020; 15: 1657-1659
    CrossrefPubMedGoogle Scholar
  • 10 Angst MS, Bührer M, Lötsch J. Insidious intoxication after morphine treatment in renal failure: delayed onset of morphine-6-glucuronide action. Anesthesiology 2000; 92: 1473-1476
    CrossrefPubMedGoogle Scholar
  • 11 Ishida JH, McCulloch CE, Steinman MA. et al. Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients. Clin J Am Soc Nephrol 2018; 13: 746-753
    CrossrefPubMedGoogle Scholar
  • 12 Thomas C. A Patient's Perspective on Benzodiazepines, Co-Dispensed Opioids, and Mortality among Patients Initiating Long-Term In-Center Hemodialysis. Clin J Am Soc Nephrol 2020; 15: 743-744
    CrossrefPubMedGoogle Scholar
  • 13 Oluyase AO, Raistrick D, Hughes E. et al. The appropriateness of psychotropic medicines: an interview study of service users attending a substance misuse service in England. Int J Clin Pharm 2019; 41: 972-980
    CrossrefPubMedGoogle Scholar
  • 14 Han Y, Balkrishnan R, Hirth RA. et al. Assessment of Prescription Analgesic Use in Older Adults With and Without Chronic Kidney Disease and Outcomes. JAMA Netw Open 2020; 3: e2016839
    CrossrefPubMedGoogle Scholar
  • 15 Zaporowska-Stachowiak I, Szymański K, Oduah MT. et al. Midazolam: Safety of use in palliative care: A systematic critical review. Biomed Pharmacother 2019; 114: 108838
    CrossrefPubMedGoogle Scholar
  • 16 Di Forti M, Quattrone D, Freeman TP. et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry 2019; 6: 427-436
    CrossrefPubMedGoogle Scholar
  • 17 Fisher E, Eccleston C, Degenhardt L. et al. Cannabinoids, cannabis, and cannabis-based medicine for pain management: a protocol for an overview of systematic reviews and a systematic review of randomised controlled trials. Pain Rep 2019; 4: e741
    CrossrefPubMedGoogle Scholar
  • 18 Likar R, Köstenberger M, Nahler G. Cannabidiol in cancer treatment. Schmerz 2020; 34: 117-122
    CrossrefPubMedGoogle Scholar
  • 19 Cheung KWA, Chan PC, Lo SH. The use of ketamine in the management of refractory cancer pain in a palliative care unit. Ann Palliat Med 2020; 9: 4478-4489
    CrossrefPubMedGoogle Scholar
  • 20 Wheeler KE, Grilli R, Centofanti JE. et al. Adjuvant Analgesic Use in the Critically Ill: A Systematic Review and Meta-Analysis. Crit Care Explor 2020; 2: e0157
    CrossrefPubMedGoogle Scholar