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Opioid Prescription, Morbidity, and Mortality in United States Dialysis Patients.
J Am Soc Nephrol. 2017 Dec; 28(12):3658-3670.JA

Abstract

Aggressive pain treatment was advocated for ESRD patients, but new Centers for Disease Control and Prevention guidelines recommend cautious opioid prescription. Little is known regarding outcomes associated with ESRD opioid prescription. We assessed opioid prescriptions and associations between opioid prescription and dose and patient outcomes using 2006-2010 US Renal Data System information in patients on maintenance dialysis with Medicare Part A, B, and D coverage in each study year (n=671,281, of whom 271,285 were unique patients). Opioid prescription was confirmed from Part D prescription claims. In the 2010 prevalent cohort (n=153,758), we examined associations of opioid prescription with subsequent all-cause death, dialysis discontinuation, and hospitalization controlled for demographics, comorbidity, modality, and residence. Overall, >60% of dialysis patients had at least one opioid prescription every year. Approximately 20% of patients had a chronic (≥90-day supply) opioid prescription each year, in 2010 usually for hydrocodone, oxycodone, or tramadol. In the 2010 cohort, compared with patients without an opioid prescription, patients with short-term (1-89 days) and chronic opioid prescriptions had increased mortality, dialysis discontinuation, and hospitalization. All opioid drugs associated with mortality; most associated with worsened morbidity. Higher opioid doses correlated with death in a monotonically increasing fashion. We conclude that opioid drug prescription is associated with increased risk of death, dialysis discontinuation, and hospitalization in dialysis patients. Causal relationships cannot be inferred, and opioid prescription may be an illness marker. Efforts to treat pain effectively in patients on dialysis yet decrease opioid prescriptions and dose deserve consideration.

Authors+Show Affiliations

Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; kimmelp@extra.niddk.nih.gov.Social and Scientific Systems, Inc., Silver Spring, Maryland.Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.Consultant Pharmacist, Olney, Maryland; and.Department of Medicine, George Washington University, Washington, DC.Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28935654

Citation

Kimmel, Paul L., et al. "Opioid Prescription, Morbidity, and Mortality in United States Dialysis Patients." Journal of the American Society of Nephrology : JASN, vol. 28, no. 12, 2017, pp. 3658-3670.
Kimmel PL, Fwu CW, Abbott KC, et al. Opioid Prescription, Morbidity, and Mortality in United States Dialysis Patients. J Am Soc Nephrol. 2017;28(12):3658-3670.
Kimmel, P. L., Fwu, C. W., Abbott, K. C., Eggers, A. W., Kline, P. P., & Eggers, P. W. (2017). Opioid Prescription, Morbidity, and Mortality in United States Dialysis Patients. Journal of the American Society of Nephrology : JASN, 28(12), 3658-3670. https://doi.org/10.1681/ASN.2017010098
Kimmel PL, et al. Opioid Prescription, Morbidity, and Mortality in United States Dialysis Patients. J Am Soc Nephrol. 2017;28(12):3658-3670. PubMed PMID: 28935654.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Opioid Prescription, Morbidity, and Mortality in United States Dialysis Patients. AU - Kimmel,Paul L, AU - Fwu,Chyng-Wen, AU - Abbott,Kevin C, AU - Eggers,Anne W, AU - Kline,Prudence P, AU - Eggers,Paul W, Y1 - 2017/09/21/ PY - 2017/01/29/received PY - 2017/07/08/accepted PY - 2017/9/25/pubmed PY - 2017/12/27/medline PY - 2017/9/23/entrez KW - Epidemiology and outcomes KW - United States Renal Data System KW - dialysis KW - end stage kidney disease KW - mortality SP - 3658 EP - 3670 JF - Journal of the American Society of Nephrology : JASN JO - J Am Soc Nephrol VL - 28 IS - 12 N2 - Aggressive pain treatment was advocated for ESRD patients, but new Centers for Disease Control and Prevention guidelines recommend cautious opioid prescription. Little is known regarding outcomes associated with ESRD opioid prescription. We assessed opioid prescriptions and associations between opioid prescription and dose and patient outcomes using 2006-2010 US Renal Data System information in patients on maintenance dialysis with Medicare Part A, B, and D coverage in each study year (n=671,281, of whom 271,285 were unique patients). Opioid prescription was confirmed from Part D prescription claims. In the 2010 prevalent cohort (n=153,758), we examined associations of opioid prescription with subsequent all-cause death, dialysis discontinuation, and hospitalization controlled for demographics, comorbidity, modality, and residence. Overall, >60% of dialysis patients had at least one opioid prescription every year. Approximately 20% of patients had a chronic (≥90-day supply) opioid prescription each year, in 2010 usually for hydrocodone, oxycodone, or tramadol. In the 2010 cohort, compared with patients without an opioid prescription, patients with short-term (1-89 days) and chronic opioid prescriptions had increased mortality, dialysis discontinuation, and hospitalization. All opioid drugs associated with mortality; most associated with worsened morbidity. Higher opioid doses correlated with death in a monotonically increasing fashion. We conclude that opioid drug prescription is associated with increased risk of death, dialysis discontinuation, and hospitalization in dialysis patients. Causal relationships cannot be inferred, and opioid prescription may be an illness marker. Efforts to treat pain effectively in patients on dialysis yet decrease opioid prescriptions and dose deserve consideration. SN - 1533-3450 UR - https://www.unboundmedicine.com/medline/citation/28935654/Opioid_Prescription_Morbidity_and_Mortality_in_United_States_Dialysis_Patients_ L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=28935654 DB - PRIME DP - Unbound Medicine ER -