Patient demographics.

BackgroundPain management in chronic kidney disease (CKD) is challenging due to altered drug metabolism, impaired excretion, and higher opioid toxicity risk. Despite this, opioids are commonly prescribed, yet real-world data on dose escalation in CKD remain limited.ObjectiveTo investigate patterns and timing of opioid dose escalation to ≥50 and ≥90 MME/day among new opioid users across kidney function levels.MethodsThis population-based cohort study used data from the Stockholm Creatinine Measurements (SCREAM) project linking diagnoses, prescriptions, and laboratory records. Adult new opioid users (no prior opioid in 12 months) from 2012–2021 were categorized by baseline eGFR (≥60, 30–59, ResultsOf 81,987 adult new opioid users, 5,987 (7.3%) escalated to ≥50 MME/day comprising 7.4%, 6.8%, and 8.1% of patients with eGFR ≥ 60, 30–59, and p p = 0.043) for those with eGFR , p )and 0.31(95% CI: 0.15–0.65, p = 0.002), respectively. Most escalation occurred within six months, with minimal increase thereafter.ConclusionOpioid dose escalation occurred across all eGFR levels, underscoring the need for cautious, individualized prescribing and close monitoring, especially in patients with reduced kidney function.