Do you recommend avoiding morphine in patients with ESKD?  

I would not recommend using other than for a few doses for acute severe pain but not for more prolonged use other than in the setting of terminal illness/hospice.

Not necessarily. Definitely would be careful about the dosing and consider significant dose adjustments. I remember years ago when meperidine was clearly contraindicated in ESRD, and we were using a significant amount of morphine instead (i.e., sickle cell patients). The risk is clearly lower with m...