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


CONCLUSIONS
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.
Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.|Multidisciplinary Pain Centre, Department of Neuroanaesthesiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
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Kurita
Stockholms Sjukhem Foundation and Department of Oncology Pathology, Karolinska Institute, Stockholm, Sweden.
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Lundström
Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.|Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Sjøgren
National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Ekholm
Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Christrup
Royal Surrey County Hospital, Guildford, UK.
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Davies
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.
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Kaasa
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.
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Klepstad
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
O
O
Dale
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005283:Fentanyl / Q000009:adverse effects / Q000627:therapeutic use; D005919:Glomerular Filtration Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology*; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D055815:Young Adult
D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl