Pain relief for kidney patients

Sunday January 14, 2007

Pain relief for kidney patients

By PROF DR TAN SI YEN, The Star Online > Health

Patients with kidney disease who require long-term pain relief need to be aware that some classes of pain relievers can cause further damage to their kidneys.

IN recent years, the trend of kidney disease among Malaysians has risen to alarming heights. According to the National Renal Registry, approximately 2,500 people develop end-stage renal disease (kidney failure) every year.1

Despite medical advances and knowledge to detect and therefore slow the progression of kidney disease, most kidney patients remain unaware of such developments. Being an insidious problem, symptoms do not appear until much later. By this time, the damage done is already significant and the patient needs to adopt significant lifestyle changes.

One of these changes affects their choice of medication. As a rule, patients whose kidney function is impaired should seek a doctor’s advice before consuming any medication, especially if the medication is used frequently and/or over a long period of time. The same holds true for pain relievers.

While most pain relievers can be used with no problems in healthy individuals, this is not the case in patients with kidney disease or impaired kidney function.

Kidney patients have to be cautious when selecting pain relievers and avoid those that can interfere with prostaglandin metabolism, which is important for blood flow through the kidneys, as this can place additional stress on the kidneys, and in the longer term, can further damage the kidneys.

This is a significant area of concern as pain relief is key to maintaining an acceptable quality of life, allowing individuals to carry on with their duties at home and work as well as to enjoy a good social life.

Pain can manifest as a simple headache, or as a severe knee or back pain that can intrude into daily activities for months and even years.

Patients with kidney disease who require long-term pain relief need to be aware that some classes of pain relievers can cause further damage to their kidneys, diminishing their function further and accelerating the need for dialysis, which can be a significant burden on the patient and the family.

Patients at high risk of analgesic/pain reliever-related kidney failure include those who have suffered heart failure or chronic kidney failure, the elderly, post-operative patients and recipients of kidney transplants.

In particular, a category known as non-steroidal anti-inflammatory drugs (NSAIDs), including the newer COX-2 inhibitors, pose a greater risk as they impair blood circulation to the kidneys.

One of the safer options for kidney patients is paracetamol, as it has the best safety profile, with the least probability of causing harm to the kidneys when compared to other pain relievers.

The National Kidney Foundation (US) provides the following advice to reduce the risk of analgesic-related kidney damage2:

# Limit the use of over-the-counter (OTC) analgesics/pain relievers to 10 days for pain and three days for fever. Any pain or fever that persists past this time-frame should be referred to a doctor as it may indicate a more serious problem.

# Avoid prolonged, concurrent use of different types of pain relievers.

# Increase your fluid intake when you are consuming pain relievers.

# Always inform your doctor about any prescription and over-the-counter medication you may be taking.

# Use NSAIDs only under a doctor’s supervision.

# Always read the warning label before consuming any pain reliever.

# Always follow the dosage instructions given by your healthcare professional on the label.

References:

1. National Renal Registry of the Clinical Research Centre, Ministry of Health Malaysia – 12th Report of the Malaysian Dialysis and Transplant Registry 2004

2. Adapted from www.kidney.org

Note: Prof Dr Tan Si Yen is a consultant nephrologist. This article is courtesy of GlaxoSmithKline. For more information e-mail starhealth@thestar.com.my. The views and opinions expressed in this column are solely that of the author’s. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

URL: http://thestar.com.my/health/story.asp?file=/2007/1/14/health/16545633&sec=health

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