Opioid prescribing common in dialysis patients

  • Ishida JH & al.
  • Clin J Am Soc Nephrol
  • 19 Apr 2018

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • >60% of Medicare Part D hemodialysis patients receive prescription opioids and nearly a quarter of those receive ≥1 high-dose prescriptions.
  • Opioid use in these patients was significantly associated with dose-dependent risks for altered mental status, fall, and fracture.

Why this matters

  • Study also identified the risk for falls, altered mental status, and fracture for specific opioids, which could help clinicians determine the best pain medications for patients already at risk for those outcomes.
  • Despite recommendations to avoid codeine, it was prescribed more often than other preferred opioids.

Study design

  • Cohort from the US Renal Data System.
  • 140,899 Medicare-covered adults who received hemodialysis in 2011 were assessed for association between opioid use and time to first hospitalization.
  • Funding: NIH.

Key results

  • 90,124 patients received opioid analgesics and 32,730 received ≥1 high-dose prescription.
  • Low- and high-dose opioids were associated with increased risk for altered mental state (aHR, 1.28 and 1.67, respectively), fall (aHR, 1.28 and 1.45, respectively), and fracture (aHR, 1.44 and 1.65, respectively; all P<.001>
  • Each 60-mg opioid dose increment was associated with 29% higher risk for altered mental status and 4% higher risk for fall and fracture (all P<.001>

Limitations

  • Medication compliance is unknown.

Coauthored with Anand Ramanathan, PharmD

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit