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Acute kidney injury is common with intravenous abuse of extended-release oral oxymorphone and delayed renal recovery rates are associated with increased KDIGO staging.
Nephrology (Carlton). 2018 Oct; 23(10):921-926.N

Abstract

AIM

Prescription opioid abuse poses a serious problem in the United States, representing 615 per 100 000 deaths annually. Extended-release oxymorphone (Opana-ER) is an oral opioid pain medication that has recently been found to cause thrombotic microangiopathy when intravenously abused. In this retrospective study, we attempted to determine the prevalence and outcomes of acute kidney injury (AKI) among patients intravenously abusing extended-release oral oxymorphone.

METHODS

A query of electronic medical records for 'drug abuse' at an academic medical centre during January 2012 to December 2015 was performed and yielded 2350 patients. Patients were further identified by documented intravenous abuse of extended-release oxymorphone. Patients were stratified based on multiple renal indices and outcomes. Potential confounders were also identified.

RESULTS

One hundred and sixty-five patients were found to have a documented history of intravenous abuse of extended-release oral oxymorphone. Prevalence of AKI in this population was a 47.8%. KDIGO stage-I patients consisted of 17.8% of patients with AKI, 40.5% were classified as KDIGO stage-II AKI, and 41.8% were classified as KDIGO stage-III AKI. Among patients with AKI, average age was found to be 37.5 years, 59.4% experienced renal recovery, 56.9% required intensive care unit admission, 13.9% progressed to end-stage renal disease (ESRD), and 7.6% expired during admission.

CONCLUSION

Clinicians should be educated to help recognize intravenous abuse of extended-release oral oxymorphone and its associated effects. Our data suggests AKI is common in these patients; higher KDIGO staging appears to be associated with slower rates of renal recovery, increased comorbidities and progression to both CKD and ESRD.

Authors+Show Affiliations

Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.Department of Internal Medicine, Section on General Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunological Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. Department of Anesthesia, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. Department of Internal Medicine, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28802086

Citation

Bonnecaze, Alex K., et al. "Acute Kidney Injury Is Common With Intravenous Abuse of Extended-release Oral Oxymorphone and Delayed Renal Recovery Rates Are Associated With Increased KDIGO Staging." Nephrology (Carlton, Vic.), vol. 23, no. 10, 2018, pp. 921-926.
Bonnecaze AK, Wilson MW, Dharod A, et al. Acute kidney injury is common with intravenous abuse of extended-release oral oxymorphone and delayed renal recovery rates are associated with increased KDIGO staging. Nephrology (Carlton). 2018;23(10):921-926.
Bonnecaze, A. K., Wilson, M. W., Dharod, A., Fletcher, A., & Miller, P. J. (2018). Acute kidney injury is common with intravenous abuse of extended-release oral oxymorphone and delayed renal recovery rates are associated with increased KDIGO staging. Nephrology (Carlton, Vic.), 23(10), 921-926. https://doi.org/10.1111/nep.13153
Bonnecaze AK, et al. Acute Kidney Injury Is Common With Intravenous Abuse of Extended-release Oral Oxymorphone and Delayed Renal Recovery Rates Are Associated With Increased KDIGO Staging. Nephrology (Carlton). 2018;23(10):921-926. PubMed PMID: 28802086.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute kidney injury is common with intravenous abuse of extended-release oral oxymorphone and delayed renal recovery rates are associated with increased KDIGO staging. AU - Bonnecaze,Alex K, AU - Wilson,Matthew W, AU - Dharod,Ajay, AU - Fletcher,Alison, AU - Miller,Peter John, PY - 2017/08/08/accepted PY - 2017/8/13/pubmed PY - 2019/3/15/medline PY - 2017/8/13/entrez KW - acute renal failure KW - extended-release oxymorphone KW - intravenous drug abuse KW - opana KW - thrombotic microangiopathy SP - 921 EP - 926 JF - Nephrology (Carlton, Vic.) JO - Nephrology (Carlton) VL - 23 IS - 10 N2 - AIM: Prescription opioid abuse poses a serious problem in the United States, representing 615 per 100 000 deaths annually. Extended-release oxymorphone (Opana-ER) is an oral opioid pain medication that has recently been found to cause thrombotic microangiopathy when intravenously abused. In this retrospective study, we attempted to determine the prevalence and outcomes of acute kidney injury (AKI) among patients intravenously abusing extended-release oral oxymorphone. METHODS: A query of electronic medical records for 'drug abuse' at an academic medical centre during January 2012 to December 2015 was performed and yielded 2350 patients. Patients were further identified by documented intravenous abuse of extended-release oxymorphone. Patients were stratified based on multiple renal indices and outcomes. Potential confounders were also identified. RESULTS: One hundred and sixty-five patients were found to have a documented history of intravenous abuse of extended-release oral oxymorphone. Prevalence of AKI in this population was a 47.8%. KDIGO stage-I patients consisted of 17.8% of patients with AKI, 40.5% were classified as KDIGO stage-II AKI, and 41.8% were classified as KDIGO stage-III AKI. Among patients with AKI, average age was found to be 37.5 years, 59.4% experienced renal recovery, 56.9% required intensive care unit admission, 13.9% progressed to end-stage renal disease (ESRD), and 7.6% expired during admission. CONCLUSION: Clinicians should be educated to help recognize intravenous abuse of extended-release oral oxymorphone and its associated effects. Our data suggests AKI is common in these patients; higher KDIGO staging appears to be associated with slower rates of renal recovery, increased comorbidities and progression to both CKD and ESRD. SN - 1440-1797 UR - https://www.unboundmedicine.com/medline/citation/28802086/Acute_kidney_injury_is_common_with_intravenous_abuse_of_extended_release_oral_oxymorphone_and_delayed_renal_recovery_rates_are_associated_with_increased_KDIGO_staging_ L2 - https://doi.org/10.1111/nep.13153 DB - PRIME DP - Unbound Medicine ER -