Renal function and symptoms/adverse effects in opioid-treated patients with cancer.

Autor: Kurita GP; Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.; Multidisciplinary Pain Centre, Department of Neuroanaesthesiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark., Lundström S; Stockholms Sjukhem Foundation and Department of Oncology Pathology, Karolinska Institute, Stockholm, Sweden., Sjøgren P; Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Ekholm O; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark., Christrup L; Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Davies A; Royal Surrey County Hospital, Guildford, UK., Kaasa S; Department of Oncology, Trondheim University Hospital, St. Olav Hospital, Trondheim, Norway.; European Palliative Care Research Centre, DMF, Norwegian University of Science and Technology, Trondheim, Norway., Klepstad P; Department of Intensive Care Medicine, St Olavs University Hospital, Trondheim, Norway.; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway., Dale O; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
Jazyk: angličtina
Zdroj: Acta anaesthesiologica Scandinavica [Acta Anaesthesiol Scand] 2015 Sep; Vol. 59 (8), pp. 1049-59. Date of Electronic Publication: 2015 May 05.
DOI: 10.1111/aas.12521
Abstrakt: Background: Renal impairment and the risk of toxicity caused by accumulation of opioids and/or active metabolites is an under-investigated issue. This study aimed at analysing if symptoms/adverse effects in opioid-treated patients with cancer were associated with renal function.
Methods: Cross-sectional multicentre study (European Pharmacogenetic Opioid Study, 2005-2008), in which 1147 adult patients treated exclusively with only one of the most frequently reported opioids (morphine/oxycodone/fentanyl) for at least 3 days were analysed. Fatigue, nausea/vomiting, pain, loss of appetite, constipation and cognitive dysfunction were assessed (EORTC QLQ-C30). Glomerular filtration rate (GFR) was estimated using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI Creatinine) equations.
Results: Mild to severe low GFR was observed among 40-54% of patients. CG equation showed that patients with mild and moderate/severe low GFR on morphine treatment had higher odds of having severe constipation (P < 0.01) than patients with normal GFR. In addition, patients with moderate/severe low GFR on morphine treatment were more likely to have loss of appetite (P = 0.04). No other significant associations were found.
Conclusion: Only severe constipation and loss of appetite were associated with low GFR in patients treated with morphine. Oxycodone and fentanyl, in relation to the symptoms studied, seem to be safe as used and titrated in routine cancer pain care.
(© 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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