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Buprenorphine Safe Opioid CKD — ESENeph MCQ

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ModerateChronic Kidney DiseaseBuprenorphine Safe Opioid CKDESENeph

A 55-year-old man with CKD G3b and chronic pain from osteoarthritis needs long-term analgesia. NSAIDs are contraindicated. Paracetamol alone is insufficient. His GP considers Tramadol but this is risky in CKD. What is a safer opioid option for moderate chronic pain in CKD?

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Correct answer: D — Buprenorphine – predominantly hepatically metabolised with no significant active metabolite accumulation in CKD; available as transdermal patches

Buprenorphine is considered one of the safer opioids in CKD because: (1) it is predominantly hepatically metabolised; (2) its metabolite (norbuprenorphine) has minimal clinical activity; (3) it does not accumulate significantly in renal failure; (4) it is available as transdermal patches (7-day formulation) providing steady-state levels without GI absorption issues. Morphine (active metabolite M6G accumulates), Codeine (morphine accumulation), Pethidine (norpethidine neurotoxicity), and Dihydrocodeine (accumulation) are all more problematic in CKD. NICE CG173 and Palliative Care formularies support Buprenorphine in CKD.

Reference: NICE CG173 – Chronic Pain; Palliative Care Formulary – Opioids in CKD