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Gabapentin and Pregabalin Use and Association with Adverse Outcomes among Hemodialysis Patients.
J Am Soc Nephrol. 2018 07; 29(7):1970-1978.JA

Abstract

Background Gabapentin and pregabalin are used to manage neuropathic pain, pruritus, and restless legs syndrome in patients on hemodialysis. These patients may be especially predisposed to complications related to these agents, which are renally cleared, but data regarding the risk thereof are lacking.Methods From the US Renal Data System, we identified 140,899 Medicare-covered adults receiving hemodialysis with Part D coverage in 2011. Using Cox regression models in which we adjusted for demographics, comorbidities, duration of exposure, number of medications, and use of potentially confounding concomitant medications, we investigated the association between gabapentin and pregabalin, modeled as separate time-varying exposures, and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture. We evaluated risk according to daily dose categories: gabapentin (>0-100, >100-200, >200-300, and >300 mg) and pregabalin (>0-100 and >100 mg).Results In 2011, 19% and 4% of patients received gabapentin and pregabalin, respectively. Sixty-eight percent of gabapentin or pregabalin users had a diagnosis of neuropathic pain, pruritus, or restless legs syndrome. Gabapentin was associated with 50%, 55%, and 38% higher hazards of altered mental status, fall, and fracture, respectively, in the highest dose category, but even lower dosing was associated with a higher hazard of altered mental status (31%-41%) and fall (26%-30%). Pregabalin was associated with up to 51% and 68% higher hazards of altered mental status and fall, respectively.Conclusions Gabapentin and pregabalin should be used judiciously in patients on hemodialysis, and research to identify the most optimal dosing is warranted.

Authors+Show Affiliations

Departments of Medicine and julie.ishida@ucsf.edu. Division of Nephrology, San Francisco Veterans Affairs Medical Center, San Francisco, California; and.Epidemiology and Biostatistics, University of California, San Francisco, California.Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California.Epidemiology and Biostatistics, University of California, San Francisco, California.Departments of Medicine and. Division of Nephrology, San Francisco Veterans Affairs Medical Center, San Francisco, California; and. Epidemiology and Biostatistics, University of California, San Francisco, California.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29871945

Citation

Ishida, Julie H., et al. "Gabapentin and Pregabalin Use and Association With Adverse Outcomes Among Hemodialysis Patients." Journal of the American Society of Nephrology : JASN, vol. 29, no. 7, 2018, pp. 1970-1978.
Ishida JH, McCulloch CE, Steinman MA, et al. Gabapentin and Pregabalin Use and Association with Adverse Outcomes among Hemodialysis Patients. J Am Soc Nephrol. 2018;29(7):1970-1978.
Ishida, J. H., McCulloch, C. E., Steinman, M. A., Grimes, B. A., & Johansen, K. L. (2018). Gabapentin and Pregabalin Use and Association with Adverse Outcomes among Hemodialysis Patients. Journal of the American Society of Nephrology : JASN, 29(7), 1970-1978. https://doi.org/10.1681/ASN.2018010096
Ishida JH, et al. Gabapentin and Pregabalin Use and Association With Adverse Outcomes Among Hemodialysis Patients. J Am Soc Nephrol. 2018;29(7):1970-1978. PubMed PMID: 29871945.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gabapentin and Pregabalin Use and Association with Adverse Outcomes among Hemodialysis Patients. AU - Ishida,Julie H, AU - McCulloch,Charles E, AU - Steinman,Michael A, AU - Grimes,Barbara A, AU - Johansen,Kirsten L, Y1 - 2018/06/05/ PY - 2018/01/26/received PY - 2018/04/23/accepted PY - 2018/6/7/pubmed PY - 2019/9/7/medline PY - 2018/6/7/entrez KW - United States Renal Data System KW - gabapentin KW - hemodialysis KW - pregabalin SP - 1970 EP - 1978 JF - Journal of the American Society of Nephrology : JASN JO - J Am Soc Nephrol VL - 29 IS - 7 N2 - Background Gabapentin and pregabalin are used to manage neuropathic pain, pruritus, and restless legs syndrome in patients on hemodialysis. These patients may be especially predisposed to complications related to these agents, which are renally cleared, but data regarding the risk thereof are lacking.Methods From the US Renal Data System, we identified 140,899 Medicare-covered adults receiving hemodialysis with Part D coverage in 2011. Using Cox regression models in which we adjusted for demographics, comorbidities, duration of exposure, number of medications, and use of potentially confounding concomitant medications, we investigated the association between gabapentin and pregabalin, modeled as separate time-varying exposures, and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture. We evaluated risk according to daily dose categories: gabapentin (>0-100, >100-200, >200-300, and >300 mg) and pregabalin (>0-100 and >100 mg).Results In 2011, 19% and 4% of patients received gabapentin and pregabalin, respectively. Sixty-eight percent of gabapentin or pregabalin users had a diagnosis of neuropathic pain, pruritus, or restless legs syndrome. Gabapentin was associated with 50%, 55%, and 38% higher hazards of altered mental status, fall, and fracture, respectively, in the highest dose category, but even lower dosing was associated with a higher hazard of altered mental status (31%-41%) and fall (26%-30%). Pregabalin was associated with up to 51% and 68% higher hazards of altered mental status and fall, respectively.Conclusions Gabapentin and pregabalin should be used judiciously in patients on hemodialysis, and research to identify the most optimal dosing is warranted. SN - 1533-3450 UR - https://www.unboundmedicine.com/medline/citation/29871945/Gabapentin_and_Pregabalin_Use_and_Association_with_Adverse_Outcomes_among_Hemodialysis_Patients_ L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=29871945 DB - PRIME DP - Unbound Medicine ER -