Safe pharmacotherapy of symptoms in patients with end-stage kidney disease – results of a questionnaire performed on physicians working in palliative care units

Introduction: Palliative care specialists are more commonly involved in the care of patients with renal insufficiency.

The aim of the study: Evaluate the knowledge of physicians working in palliative care about prescribing essential drugs used for symptom control in patients with end-stage kidney disease.

Material and methods: Physicians working in palliative care were asked to fill in a questionnaire on prescribing 40 essential drugs used for symptom control in patients with end-stage kidney disease (GFR < 15 ml/min/1.73 m²).

Results: The questionnaire was filled in by 65 physicians. The percentage of correct answers to all questions equalled 36.9–81.5. The respondents showed the best knowledge of the principles of using analgesics. The most erroneous responses concerned antiepileptics, mirtazapine, venlafaxine, ibandronic acid, and baclofen. In the case of 13.8–58.3% of answers, drugs that should be avoided if possible in patients with significant renal impairment were erroneously classified as safe or to be used cautiously in reduced doses, which concerned non-steroidal anti-inflammatory drugs, diazepam, phenytoin, mirtazapine, duloxetine, venlafaxine, risperidone, phenobarbital, bisphosphonates, and baclofen. Based on the literature, the basic recommendations for the correct prescribing of medicines used to relieve symptoms in patients with impaired renal function are presented the discussion.

Conclusions: The presented study indicates insufficient level of knowledge among palliative care physicians about the choice and dosage of medicines used to relieve symptoms in patients with end-stage kidney disease, and the need to develop recommendations on this topic.