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Analysis highlights risks associated with opioid use among patients on hemodialysis
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Greater risks of adverse events such as altered mental status, falls and fractures were associated with opioid use among patients on hemodialysis, according to an analysis in Clinical Journal of the American Society of Nephrology. The findings suggest use of these drugs be limited when possible.
“Patients receiving hemodialysis are at risk of complications related to opioid use, even when lower-dosing and recommended agents are used,” Julie H. Ishida, MD, MAS, from the division of nephology in the department of medicine at the University of California, San Francisco and San Francisco Veterans Affairs Medical Center, told Healio Nephrology. “The risks and benefits of using opioids in this population should be carefully weighed, and future research investigating alternative therapies for managing pain is needed.”
In a retrospective cohort study, Ishida and colleagues examined information from 140,899 Medicare Part D-covered adults who received in-center dialysis in 2011.
Investigators found 64% of patients received an opioid prescription. Of these patients, 11%, 5% and 3% had an episode of altered mental status, fall and fracture in a dose-dependent manner requiring an ER visit or hospitalization, respectively.
According to the study, the findings are consistent with limited epidemiologic evidence suggesting patients on hemodialysis receiving opioids are at higher risk of major complications, even when patients were not prescribed high doses.
The median age of the cohort was 61 years. About half of the patients were men and half were white; however, opioid use was associated with younger age, women, black race, higher BMI and higher prevalence of comorbidities.
Of the 64% prescribed opioids, 23% had at least one high-dose prescription. According to the study, the prevalence of use of the individual agents of interest was as follows: hydrocodone (43%); oxycodone (22%); tramadol (15%); codeine (7%); hydromorphone (3%); fentanyl (3%); morphine (2%); and methadone (1%). – by Jake Scott
Disclosures: The authors reported no relevant financial disclosures.
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