title: Intradialytic clearance of opioids: methadone versus hydromorphone.
abstract: Opioids are commonly prescribed to patients with chronic pain associated with end-stage renal disease requiring hemodialysis. The stability of opioid analgesia during dialysis may vary among different opioids. No studies to date have corroborated this clinical observation by directly comparing plasma concentrations of different opioids during dialysis. We compared changes in peridialysis plasma concentrations of 2 pharmacokinetically distinct opioids, methadone and hydromorphone (HM). Fourteen dialysis patients with chronic pain received either methadone or HM for at least 2 weeks before beginning the study. Blood samples were obtained immediately before, during, and after hemodialysis in 2 separate dialysis sessions, 1 week apart, and were analyzed for opioid concentrations. Methadone plasma concentrations were more stable during hemodialysis compared to HM: the mean percent change of methadone plasma levels was 14.9% ± 8.2% (± SD) compared with 55.1% ± 8.1% in the HM treatment group, a difference of 40.2% (95% confidence interval 17.14 to 63.14). The mean plasma clearance of methadone was 19.9 ± 8.5 mL/min (± SD) compared with 105.7 ± 8.3 mL/min for HM, a difference of 85.7 mL/min (95% confidence interval 61.9 to 109.1). There were no differences between the 2 opioid groups in pain scores, side effect profile, and quality of life. Methadone therapy was not associated with an increased rate of adverse events. If confirmed by larger clinical studies, methadone could be considered as one of the opioids of choice in dialysis patients.
authors: Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Canada Department of Anesthesiology, McGill University Health Centre, Montreal, Canada Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
authors: Ryan
authors: R
authors: Perlman
authors: Hili
authors: H
authors: Giladi
authors: Krista
authors: K
authors: Brecht
authors: Mark A
authors: MA
authors: Ware
authors: Terence E
authors: TE
authors: Hebert
authors: Lawrence
authors: L
authors: Joseph
authors: Yoram
authors: Y
authors: Shir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004091:Hydromorphone / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy*; D008297:Male; D008657:Metabolic Clearance Rate / Q000502:physiology*; D008691:Methadone / Q000097:blood*; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods
chemical_list: D000701:Analgesics, Opioid; D004091:Hydromorphone; D008691:Methadone
keywords: Chronic pain; Dialysis; Hydromorphone; Methadone; Pharmacokinetics
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