title: Dialyzability of Oxycodone and Its Metabolites in Chronic Noncancer Pain Patients with End-Stage Renal Disease.
abstract: Opioids are the preferred analgesic drugs to treat severe chronic pain conditions among dialysis patients; however, knowledge about their dialyzability features is limited. Oxycodone is increasingly used for the treatment of chronic pain conditions as oral controlled release (CR) tablets; however, evidence about this drug and its metabolites' dialyzability is lacking.
  
  
  
  We assessed, during 4-hour dialysis sessions, the effect of standard hemodialysis (HD) and online hemodiafiltration (HDF) methods on the plasma concentration of oxycodone and its metabolites in n = 20 chronic pain patients with end-stage renal disease who were stably treated with oral CR oxycodone. Chromatographic techniques were used to evaluate the studied compounds' plasma concentrations at three different time points during dialysis.
  
  
  
  Mean plasma concentrations of oxycodone and noroxycodone in the sample showed an overall reduction trend over time, but it was less enhanced for noroxycodone. Mean reduction in oxycodone and noroxycodone arterial concentrations was significant and higher with HDF (54% and 27%, respectively) than with HD (22% and 17%, respectively). Analysis of the regression of these compounds' clearance on their increasing arterial concentration showed a more stable and linear clearance prediction with HDF (roughly 85 mL/min); with HD, for increasing arterial concentration, clearance of oxycodone decreased while noroxycodone clearance increased.
  
  
  
  While no oxymorphone or noroxymorphone metabolites were detected, limited dialyzability of oxycodone and noroxycodone was documented along with insignificant postdialysis pain increment. This evidence will contribute toward considerations as to the safety of the use of oxycodone in dialysis patients in the future.
authors: Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.|Anesthesiology and Intensive Care Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.|Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy.
authors: Boaz Gedaliahu
authors: BG
authors: Samolsky Dekel
authors: Nephrology, Dialysis and Renal Transplant Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.|Post Graduate School of Nephrology, University of Bologna, Bologna, Italy.
authors: Gabriele
authors: G
authors: Donati
authors: Anesthesiology and Intensive Care Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.|Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy.
authors: Alessio
authors: A
authors: Vasarri
authors: Nephrology, Dialysis and Renal Transplant Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.|Post Graduate School of Nephrology, University of Bologna, Bologna, Italy.
authors: Anna Laura
authors: AL
authors: Croci Chiocchini
authors: Anesthesiology and Intensive Care Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.|Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy.
authors: Alberto
authors: A
authors: Gori
authors: Nephrology, Dialysis and Renal Transplant Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.|Post Graduate School of Nephrology, University of Bologna, Bologna, Italy.
authors: Giuseppe
authors: G
authors: Cavallari
authors: Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.|Anesthesiology and Intensive Care Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.|Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy.
authors: Gianfranco
authors: G
authors: Di Nino
authors: Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy.
authors: Laura
authors: L
authors: Mercolini
authors: Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy.
authors: Michele
authors: M
authors: Protti
authors: Department for Life Quality Studies, University of Bologna, Rimini, Italy.
authors: Roberto
authors: R
authors: Mandrioli
authors: Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.|Anesthesiology and Intensive Care Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.|Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy.
authors: Rita Maria
authors: RM
authors: Melotti
authors: Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.|Nephrology, Dialysis and Renal Transplant Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.|Post Graduate School of Nephrology, University of Bologna, Bologna, Italy.
authors: Gaetano
authors: G
authors: La Manna
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000097:blood* / Q000627:therapeutic use; D002908:Chronic Disease; D059350:Chronic Pain / Q000188:drug therapy; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009019:Morphinans / Q000097:blood; D010098:Oxycodone / Q000097:blood* / Q000627:therapeutic use; D010111:Oxymorphone / Q000097:blood; D006435:Renal Dialysis
chemical_list: D000701:Analgesics, Opioid; D009019:Morphinans; C077256:noroxycodone; C526569:noroxymorphone; D010111:Oxymorphone; D010098:Oxycodone
keywords: chronic pain; dialysis; end-stage renal disease; online dialysis; oxycodone; oxycodone metabolites