Patients treated with maintenance hemodialysis frequently suffer from chronic pain, which has poor outcomes and negatively affects their quality of life. In earlier studies, it has been shown that almost 50% of patients with hemodialysis-dependent kidney failure have chronic moderate-to-severe pain. Unfortunately, pain management is often ineffective in such patients as they complain of insufficient treatment.

Opioids can be used as therapy for pain management in patients treated with maintenance hemodialysis. However, the challenge is that opioids are often overprescribed and are linked to increased dialysis discontinuation, hospitalization, and mortality. Besides, opioid use is also associated with several potential risks. Therefore, it is recommended that opioid use be customized as per the patient based on shared decision-making and implemented cautiously. Also, in the case of kidney failure and hemodialysis, the pharmacokinetics and metabolism of some opioids are affected, further complicating their use in clinical practice. Monitoring the patient, screening for and managing opioid use disorder is an essential aspect of safe opioid prescribing. 

Buprenorphine is a good analgesic option for patients treated with hemodialysis. It has many unique pharmacological properties which should be appropriately understood for safe and effective prescribing. 

Reference: 1. Tobin DG, Lockwood MB, Kimmel PL, et al. Opioids for chronic pain management in patients with dialysis-dependent kidney failure. Nature reviews Nephrology. 2021. DOI: https://doi.org/10.1038/s41581-021-00484-6