Supplementary Material for: Opioid analgesic use among patients with kidney disease: a systematic review

Introduction: Opioid analgesics are often used to manage moderate to severe pain. A significant proportion of patients taking opioids have compromised kidney function. This systematic review aimed to examine the available evidence on the safety and analgesic effect of opioid use in adults with kidney disease.
Methods: We searched eight electronic databases from inception to 26th January 2023. Published original research articles in English reporting on opioid use and pharmacokinetic data among adults with reduced renal function were included. Article screening, data extraction, and quality assessment were conducted by at least two investigators independently. This review was registered prospectively on PROSPERO (ID: CRD42020159091).
Results: There were 32 observational studies included, 14 of which reported on morphine use, three involved fentanyl use, two involved hydromorphone use and 13 articles reported on other opioids including codeine, dihydrocodeine, and buprenorphine.
Conclusion: There is limited and low-quality evidence to inform the safety and analgesic effect of opioid use in reduced renal function. Morphine remains the opioid for which there is the most evidence available on safety and analgesic effect in the context of renal disease. Greater caution and consideration of potential risks and benefits should be applied when using other opioids. Further high-quality studies examining clinical outcomes associated with the use of different opioids and opioid doses in renal disease are warranted.

引言：阿片类镇痛药（opioid analgesics）常被用于控制中重度疼痛。服用阿片类药物的患者中，有相当比例存在肾功能受损情况。本系统评价（systematic review）旨在探究现有关于肾病成人患者使用阿片类药物的安全性及镇痛效果的证据。
方法：本研究检索了8个电子数据库，检索时限从建库至2023年1月26日。纳入以英文发表的、针对肾功能减退成人患者的阿片类药物使用及药代动力学（pharmacokinetic）相关原创研究论文。文献筛选、数据提取及质量评价均由至少2名研究人员独立完成。本系统评价已在PROSPERO平台进行前瞻性注册（注册号：CRD42020159091）。
结果：共纳入32项观察性研究（observational study），其中14项针对吗啡使用情况，3项涉及芬太尼（fentanyl）使用，2项涉及氢吗啡酮（hydromorphone）使用，另有13篇文献报道了包括可待因（codeine）、双氢可待因（dihydrocodeine）及丁丙诺啡（buprenorphine）在内的其他阿片类药物相关内容。
结论：现有关于肾功能减退患者使用阿片类药物的安全性与镇痛效果的证据有限且质量较低。在肾病患者中，吗啡是目前证据最为充分的阿片类药物。使用其他阿片类药物时，应更加谨慎，充分权衡潜在风险与获益。亟需开展高质量研究，探究肾病患者使用不同阿片类药物及不同阿片类药物剂量相关的临床结局。