Table 2.
Characteristics and Results of Included Studies.
| Study | Country | Patient population | Study design | Number of patients | Mean age (Years) | Analgesic use prevalence |
|---|---|---|---|---|---|---|
| Bailie et al 14 | United States | Prevalent HD | Prospective observational study (United States DOPPS data) |
3749 | 61 | In 2000 the prevalence of analgesic prescription in the study population was 24.3%. 4.9% of the entire study population was prescribed COX-2 agents in 2000. The total prevalence of patients prescribed a narcotic was 14.9% in 2000. Prevalence of combination use of a narcotic and COX-2 agent was 1.2%. The total prevalence of any NSAID prescription in 2000 was 2.3%. Prevalence of prescription combining a narcotic and a NSAID was 0.6% while the prevalence of combination use of a COX-2 agent and a NSAID was 0.2%. The total prevalence of acetaminophen use in the study population was 6.3%. The prevalence of prescriptions for combination use of a narcotic and acetaminophen was 1.7% and 0.5% for a combination of acetaminophen and a COX-2 agent. In 2000, 0.3% of the study population had a prescription for Acetaminophen combined with a NSAID. |
| Bailie et al 15 | France, Germany, Italy, Spain, United Kingdom, Japan, United States | Prevalent HD | Cross-sectional, prospective, observation study (DOPPS I data) |
Total: 8628 N for analgesic prevalence calculation: 8455 |
60 (Calculated with n = 8542) |
In 2000, the prevalence of NSAID use was 5.3%, 4.4% for acetaminophen, and narcotic use had a prevalence of 9.5% |
| Barrantes et al 16 | United States | Transplant | Single center retrospective study | Total: 1064 Chronic opioid usage: 108 No chronic opioid usage: 956 |
Chronic opioid usage: 51 No chronic opioid usage: 49 |
Of the total study population 10.2% had a history of chronic opioid usage prior transplantation. Of those that used opioid medications the most prevalent were hydrocodone (43.1%), propoxyphene (18.1%), oxycodone (16.4%), tramadol (13.8%), others (8.6%). Prevalence of a nonopioid analgesic was 10.1% of the total study population. |
| Battistella et al 40 | Canada | Prevalent HD | Descriptive, retrospective, cross-sectional study | 3134 | 77 | The total prevalence of prescriptions for opioid medication was 25.5%, 5.5% for NSAID and 3.5% for aspirin. |
| Bouattar et al 17 | Morocco | Prevalent HD | Cross-sectional study | 67 | 44 | The total prevalence of analgesic use 50.7%. Of those that used analgesics, 52.9% used a weak opioid and 47.1% used nonopioid analgesics. |
| Carreon et al 18 | United States | Prevalent HD | Cross-sectional analysis of a cohort of HD patients | Total: 75 With bone/joint pain: 27 (Analgesic use data unavailable for 1 patient that reported pain) |
59 | Of the patients reporting bone/joint pain (that had analgesics data available) 48.1% were receiving analgesic treatment. Six patients were taking both a narcotic and over-the-counter agent, 4 were taking a narcotic only, and 3 were using over-the-counter NSAIDs or acetaminophen. There were 22 other patients on analgesic therapy who did not report bone/joint pain. 73% of these patients without bone/joint pain were receiving NSAIDs and/or acetaminophen, while 27% were prescribed narcotics. |
| Chan et al 43 | Hong Kong | CKM | Intervention | 253 | Patients with Pain: 79 Patients without Pain: 80 |
At baseline of those patients with significant pain (Edmonton Symptom Assessment System pain score ≥ 4) 56.5% were on a regularly scheduled analgesic: 43.5% patients received regular acetaminophen, 2% were on weak opioid (tramadol), and 11% on other alternatives (gabapentin/pregabalin/sodium valproate). |
| Claxton et al 19 | United States | Prevalent HD | Prospective observational, cross-sectional study | 62 | 59 | Opioids and gabapentin were the most frequently prescribed for pain (32% for both). The prevalence of prescription acetaminophen was 26%, 11% for tramadol, and 16% for NSAIDs. |
| Daubresse et al 44 | United States | Prevalent HD | Retrospective cohort study | 2007-2014: 484 745 2007: 163 558 2014: 208 807 |
Not available | The percentage of patients undergoing hemodialysis who received an opioid prescription slightly increased from 62.4% in 2007, 62.5% in 2008, 62.8% in 2009 and 63.2% in 2010. The prevalence of opioid usage declined to 62.4% in 2011, 60.9% in 2012, and 60.2% in 2013. By 2014, the proportion of patients received an opioid declined to 53.7%. |
| Davison 20 | Canada | Prevalent HD | Prospective cohort study | Total: 205 With pain: 103 No pain:102 |
60 | Of the patients reporting pain 35% were administered no analgesics, 29.1% were administered nonopioid analgesics, 26.2% were administered weak opioids, and 9.7% were administered strong opioids. Two types of weak opioids were administered concurrently in 6 patients and 2 types of strong opioids were administered concurrently in 3 patients. The prevalence of nonopioid medication was 21.4% for acetaminophen, 5.8% for NSAIDs and 1.9% for Adjuvant only. Adjuvant therapy was used in combination with analgesics for 22 patients (21.4%). The prevalence of weak opioid medication was 20.4% for codeine, 3.9% for propoxyphene, 1.0% for pethidine, and 6.8% for oxycodone. The prevalence of strong opioid medication was 5.8% for hydromorphone, 2.9% for methadone, 1.9% for fentanyl, and 1.9% for morphine. |
| Desmet et al 21 | Belgium | Prevalent HD | Prospective multicenter cohort study | Total: 308 Falls: 39 No falls: 269 |
Falls: 73 No fall: 66 |
The prevalence of opioid derivative medication use was 28.2% patients with falls used and 9.7% patients without falls. |
| Dorks et al 22 | Germany | Nursing home residents (Categorized by renal function) |
Multicenter cross-sectional study | Total: 685 CCR ≥ 90: 84 CCR 60-89: 165 CCR 30-59: 330 CCR < 30: 106 |
83 | In the subgroup of residents with moderate renal failure (CCR 30-59), 48.2% were treated with NSAIDs. In the subgroup of residents with severe renal failure (CCR < 30), 15.8% were treated with NSAIDs. The most commonly used NSAIDs was ibuprofen (92.0 %), diclofenac (4.0 %), and acemetacin (4.0 %). |
| El Harraqui et al 23 | Morocco | Prevalent HD | Cross-sectional study | 93 | 52 | The total prevalence of analgesic use in the study population was 53.8%. Of the patients using analgesics 68.0% were using nonopioid medication and 44% were using an opioid. |
| Elder et al 24 | France, Germany, Italy, Spain, United Kingdom, Japan, United States | Prevalent HD | Prospective observational study (DOPPS data) |
Total: 6321 Good sleepers: 3189 Poor Sleepers: 3132 |
Good sleepers: 59 Poor sleepers: 59 |
The total prevalence of prescribed narcotic medications was 34.1% in the poor sleep quality group and 22.4% in the good sleep quality group. |
| Finkelstein et al 25 | United States | Prevalent HD (At home short daily HD patients) |
Prospective, observational cohort study (FREEDOM Study) |
291 | 53 | The total prevalence of analgesic use in the study population was 36.4%. |
| Fleishman et al 45 | Israel | Prevalent HD | Cross-sectional survey study | 336 | 63 | Of the 277 patients with pain, 66.1% reported being regularly treated with pain medication. Based on purchase data, 63% of patients purchased some analgesics over the year before study interview: 31% of patients purchased nonopioid medications, 21% weak opioids, and 11% strong opioids. |
| Gamondi et al 26 | Switzerland | Prevalent HD | Cross-sectional, observational multicenter study | 123 | 71 | Of the 81 patients reporting pain. 80.2% were using NSAIDs, 16.0% were treated with weak opioids, and 4.9% with strong opioids. Other pain specific pharmacotherapy prevalence for patients reporting pain was and 11.1% for neuropathic pain medication. |
| Gómez Pozo et al 46 | Spain | Prevalent HD | Observational, descriptive, transversal study | 134 | 68 | The overall prevalence of analgesic use was 60%. Of those using an analgesic medication, 82% were using a nonopioid, 12% were using a weak opioid, and 6% were using a strong opioid. The prevalence of analgesic use for musculoskeletal pain was 9.1%. |
| Guirguis-Blake et al 47 | United States | Predialysis CKD Stage 3-5 | Cross-sectional descriptive study | 373 | Not Available | The prevalence of a NSAID prescription was 34.0%. |
| Heleniak et al 27 | Poland | Predialysis CKD Stage 1-4 Prevalent HD or PD Transplant |
Cross-sectional survey study | Total: 972 CKD 1-4: 574 PD: 44 HD: 40 Transplant: 314 |
Total: 55 CKD 1-4: 57 PD: 56 HD: 61 Transplant: 50 |
In the hemodialysis patient group 42.5% reported they did not use NSAIDs, 10% reported they used NSAIDs a few times a year, 12.5% reported few times a month, 17.5% reported using NSAIDs a few times a week, and 17.5% reported daily use. In the peritoneal dialysis patient group, 43.2% reported they did not use NSAIDs, 29.5% reported they used NSAIDs a few times a year, 18.2% reported few times a month, 4.5% reported using NSAIDs a few times a week, and 4.5% reported daily use. |
| Hull et al 28 | East London, United Kingdom | Stage 3-5 CKD (GFR < 60) predialysis | Cross-sectional, database review study | 12 011 | 71 | The prevalence of a NSAID prescription for patients with Stage 3 CKD was 11.5%, 5.5% for Stage 4, and 3.0% for Stage 5. |
| Iacono 29 | United States | Prevalent HD | Cross-sectional observational study | 45 | Not Available | 30% of patients reported taking prescription medication to control pain. |
| Ingrasciotta et al 30 | Italy | CKD (Stage not specified; Identified by CKD-related ICD 9 code among cause for hospitalizations, procedures in hospital & drug prescriptions) |
Chart review/ cross-sectional study | Incident CKD: 1989 Patients with Incident CKD receiving dialysis during follow-up: 112 |
Not Available | Data from 112 patients 1 year after starting dialysis showed the prevalence of at least one prescription NSAID was 29.5%. The most commonly most commonly reported NSAID use was nimesulide (7.1%), diclofenac (6.3%), ketoprofen (8.0%), coxib (6.3%), piroxicam (0.9%), and ketorolac (7.1%) The combined prevalence of use for other NSAIDs was 4.5%. |
| Ishida et al 48 | United States | Prevalent HD | Observational cohort study | 140 899 | Median age: 61 (51-72) | The prevalence of an opioid prescription opioid was 64% in 2011. The prevalence of individual opioid medications was as follows: hydrocodone (43%), oxycodone (22%), tramadol (15%), codeine (7%), hydromorphone (3%), fentanyl (3%), morphine (2%), and methadone (1%). |
| Iwagami et al 53 | United Kingdom | CKD (GFR < 60) predialysis CKM |
Matched cohort study | Patients with CKD: 242 379 Patients without CKD: 242 349 |
Not available | Of the 202 291 CKD patients followed up, 1.7% were on tricyclic antidepressants and had neuropathic pain. |
| Jadoul et al 31 | Australia, New Zealand, Belgium, Canada, France, Germany, Italy, Spain, Sweden, United Kingdom, United States | Prevalent HD | Prospective observational study (DOPPS II data) |
12 782 | Not available | The prevalence of narcotic combinations (eg, acetaminophen-codeine, acetaminophen-hydrocodone, and acetaminophen-oxycodone) use was 5.6% while the prevalence of narcotic only use was 3.0%. |
| Jhamb et al 49 | United States | CKD Stage 4-5 (not on dialysis) Prevalent dialysis (does not specify) |
Post hoc analysis of a prospective cohort study | Predialysis CKD Stage 4-5: 82 Dialysis: 149 |
CKD Stage 4-5 (not on dialysis): 52 Dialysis: 56 |
The prevalence of analgesic use was 50.0% in the nondialysis group. Of those reporting significant pain, visual analog scale (VAS) score ≥ 5/10, 80.0% reported pain medication use. The prevalence of analgesic use was 35.9% in the dialysis group. Of those reporting significant pain (VAS score ≥ 5/10), 48.6% reported pain medication use. |
| Keohane et al 50 | United Kingdom | CKD (GFR <60) | Post hoc analysis of a prospective cohort study | Total: 158 Stage 3: 146 Stage 4: 10 Stage 5: 2 |
76 | The prevalence of a NSAID prescription was 10.12% for the CKD stage 3-5 cohort. The prevalence of individual NSAID was as follows: Cox-2 (5.7%), dexketoprofen (1.9%), ibuprofen (1.3%), and diclofenac (0.6%). |
| Kimmel et al 38 | United States | Prevalent HD or PD | Cohort study | 153 758 | Not available | In 2010, 64% of the study population had a prescription for opioid medication. Of those, 41% were short-term (<90 days) and 23% chronic prescription (≥90 days). Of the chronic opioid prescription, 11.7% had a prescription for hydrocodone, 5.4% for oxycodone, 1.4% propoxyphene, 2.5% tramadol, 0.6% codeine, 0.7% morphine, 0.6% hydromorphone, 1.3% fentanyl. In 2010, 14.2% of the study population had a prescription for a nonopioid analgesic. |
| Kristensen et al 39 | Denmark | Prevalent dialysis (does not specify) |
Cross-sectional study | 6663 | 62 | The total prevalence of NSAID use in the study population was 18.4% 1 year prior to starting renal replacement therapy. Of the NSAIDs reported, the prevalence of use was 7.9% for ibuprofen, 4.6% for diclofenac, 1.1% for rofecoxib, 0.8% for celecoxib, 1.3% for naproxen, and 5.3% for other NSAIDs. |
| Mahmoud et al 32 | Tunisia | Stage 3-5 CKD (Admitted with superimposed AKI) |
Prospective case-control study | Case patients:58 Stage 3: 19 Stage 4: 34 Stage 5: 5 Control: 114 |
67 | Nine case patients out of 58 (15.5%) had used NSAIDs within 30 days of AKI episode, whereas 5 control patients out of 114 (4.4%) had used NSAIDs in the last 30 days. |
| Masajtis-Zagajewska et al 33 | Poland | Prevalent HD Transplant |
Cross-sectional study | HD: 164 Transplant: 114 |
HD: 61 Transplant: 47 |
Of the 120 hemodialysis patients with chronic pain 15% reported no analgesic use, 50% used paracetamol, 49.1% used metamizol, 36.6% used ketoprofen, 11.7% used diclofenac, 28.3% used ibuprofen, 13.3% reported Other NSAID use, 16.7% reported use of tramadol, and 1.7% reported using opioid medication. |
| Mina et al 51 | United States | Prevalent HD | Retrospective cohort study | 140 899 | Muscle relaxant use: 56 No muscle relaxant use: 61 |
The prevalence of muscle relaxant use was 10.2%. The prevalence of use for individual agents was as follows: cyclobenzaprine (6.8%), carisoprodol (1.4%), methocarbamol (1.2%), baclofen (0.7%), tizanidine (0.7%), orphenadrine citrate (0.2%), metaxalone (0.2%), chlorzoxazone (0.08%), and dantrolene sodium (0.02%). |
| Otsuki et al 34 | Japan | Prevalent HD (with neuropathic pain) |
Prospective, open-label, single-arm, multicenter trial | Included: 45 Analyzed: 35 |
72 (68-76) | The total prevalence of NSAID use in the study population was 20%. |
| Ou et al 35 | Taiwan | Prevalent HD | Nationwide, population-based case-control study | Total: 55 742 Before matching: 12 486 NSAID users and 43 256 nonusers Matched cohort pairs: 11 699 patients using NSAIDs and 11 699 controls |
Not using NSAID: 59 Using NSAID: 58 |
The total prevalence of NSAID use in the study population was 22.4%. |
| Plantinga et al 41 | United States | CKD (GFR ≥ 15) Predialysis | Cross-sectional study | Total: 12 065 No CKD: 9604 Mild CKD (Stage 1-2): 1137 Moderate-severe CKD (Stage 3-4): 1324 |
Total: 51 No CKD: 47 Mild CKD: 58 Moderate-severe CKD: 73 |
The prevalence of reported NSAID use in the moderate to severe CKD group was 5.7%. |
| Rodriguez Calero et al 36 | Spain | Prevalent HD | Descriptive transversal cohort study | 32 | 67 | 34.3% of patients did not report analgesics use. The total prevalence of paracetamol use in the study population was 65.6%. The prevalence of weak opioid use was 25% and strong opioid use was reported by 15.6%. The prevalence of adjuvant use was 31.2% if the study population. |
| Wu et al 37 | United States | CKD (GFR < 60) predialysis | Descriptive cohort study (Use baseline data from the safe kidney cohort study) |
Total: 308 No chronic pain: 121 Mild pain: 97 Severe pain: 90 |
No chronic pain: 66 Mild: 67 Severe: 65 |
Of the NSAIDs reported the prevalence of use was 2.3% for aspirin (dosage > 325mg), 1.9% for ibuprofen, 1.6% for naproxen, 0.9% for indomethacin, 0.3% for diclofenac, 0.3% for etodolac, and 0.3% for salsalate. The prevalence of opioid use was 15.3% for tramadol, 8.1% for oxycodone, 3.2% for codeine, 2.6% for hydrocodone with acetaminophen, 0.9% for morphine, and 0.3% for methadone. Of the other analgesics recorded, the prevalence of use was 33.8% for acetaminophen, 0.6% for butalbital with acetaminophen and caffeine, and 0.3% for sulfasalazine. |
| Yesil et al 52 | Turkey | Prevalent HD | Cross-sectional survey study | 70 | 45 | Of the 53 patients with pain the prevalence of analgesic use was 54.7% |
| Zhan et al 42 | United States | CKD (GFR 20-70) predialysis | Observational cohort study (Chronic Renal Insufficiency Cohort Study) |
Total: 3872 Stage 1/2: 389 Stage 3A: 1242 Stage 3B: 1486 Stage 4/5: 755 |
21-74 | At baseline the prevalence of reported NSAID use in the stage 3A group was 31.1%. The stage 3B group had a NSAID use prevalence of 20.2%. The prevalence of NSAID used declined to 8.9% in the stage 4/5 group. |
Note. HD = hemodialysis; DOPPS = Dialysis Outcomes and Practice Patterns Study; COX-2 = cyclooxygenase-2; NSAID = nonsteroidal anti-inflammatory drug; CCR = creatinine clearance; FREEDOM = Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease; CKD = chronic kidney disease; GFR = glomerular filtration rate; CKM = conservative kidney management; PD = peritoneal dialysis; ICD = International Statistical Classification of Diseases and Related Health Problems; AKI = acute kidney injury.