Clinical Considerations for Opioid Use in Renal Impairment

Drug Selection and Monitoring

• The American Society of Nephrology recommends opioids with no active metabolites, such as fentanyl, sufentanil, and methadone, for patients with renal insufficiency 3
• Drug selection in acute kidney disease should be guided by the functional phase, trajectory, and stage of AKD, considering factors such as renal versus non-renal excretion, potential for nephrotoxicity, effect of AKD on metabolites, urgency for use of the drug, and availability of suitable alternatives 1
• Patients with renal impairment receiving hydromorphone should be monitored for signs of opioid toxicity 3
• Do not administer multiple nephrotoxic medications concomitantly with hydromorphone when possible, as this may worsen renal function 1, 4
• Have naloxone available for patients with renal impairment receiving opioids due to higher risk of toxicity 3