{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T18:18:38Z","timestamp":1774030718561,"version":"3.50.1"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Pain 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate patterns and timing of opioid dose escalation to \u226550 and \u226590 MME\/day among new opioid users across kidney function levels.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This 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\u20132021 were categorized by baseline eGFR (\u226560, 30\u201359,\u2009<\u200930 mL\/min\/1.73m\u00b2). Opioids were identified using ATC codes, and daily doses (MME\/day) were calculated based on strength, quantity, and equianalgesic ratios. Fine\u2013Gray competing-risks regression assessed time to dose escalation (\u226550 and \u226590 MME\/day), accounting for death as a competing event.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 81,987 adult new opioid users, 5,987 (7.3%) escalated to \u226550 MME\/day comprising 7.4%, 6.8%, and 8.1% of patients with eGFR\u2009\u2265\u200960, 30\u201359, and <30 mL\/min\/1.73m\u00b2, respectively. For \u226590 MME\/day, 2,067 (2.5%) escalated, 2.5%, 2.3%, and 2.9% across the same eGFR categories. Competing risks regression showed significantly lower risks of escalation among patients with reduced eGFR levels. For \u226550 MME\/day, the sub distribution hazard ratios (SHRs) were 0.67 (95% CI: 0.56\u20130.81,\n p<\/jats:italic>\n \u2009<\u20090.001) for eGFR 30\u201359 and 0.64 (95% CI: 0.42\u20130.99,\n p<\/jats:italic>\n \u2009\n =\u20090.043)<\/jats:italic>\n for those with eGFR\u2009<\u200930.For \u226590 MME\/day, SHRs were 0.57 (95% CI: 0.43\u20130.75\n , p\u2009<\u20090.001<\/jats:italic>\n )and 0.31(95% CI: 0.15\u20130.65,\n p\u2009=\u20090.002<\/jats:italic>\n ), respectively. Most escalation occurred within six months, with minimal increase thereafter.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Opioid dose escalation occurred across all eGFR levels, underscoring the need for cautious, individualized prescribing and close monitoring, especially in patients with reduced kidney function.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0345309","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:28:53Z","timestamp":1774027733000},"page":"e0345309","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patterns of opioid dose escalation in patients with chronic kidney disease initiated on opioids for the treatment of non-cancer pain"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5572-2719","authenticated-orcid":true,"given":"Che 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