Patients suffering from chronic kidney disease (CKD) are a special group of patients, especially those with advanced renal failure/end-stage renal disease (ESRD) before dialysis and renal replacement therapy (RRT). CKD causes many therapeutic problems. The pharmacokinetics of drugs used, including opioid analgesics, is influenced by the degree of kidney damage and, ultimately, by RRT. The choice of opioid analgesic is crucial to ensure an optimal analgesic effect in relation to possible side effects. For dialysis patients, several important factors must additionally be taken into account, such as molecular weight of a drug, water solubility and volume of distribution. In the management of chronic pain in ESRD patients and dialysis patients, there are in practice limitations in terms of the use of lipophilic drugs. The drugs of choice seem to be opioids administered via transdermal route, such as buprenorphine and fentanyl, and in the next line of treatment — methadone for opioid rotation. On the other hand, opioid antagonists that were previously used only in the case of opioid overdose are currently being used in the treatment of opioid-induced bowel dysfunction, especially in opioid-induced constipation.