Opioid Use Raises Risk of Hospitalization, Death in Dialysis Patients

Prescription opioid use is associated with higher risks for mortality, discontinuation of dialysis, and hospitalization among patients on maintenance dialysis, according to a recent study.

Although aggressive pain treatment previously was advocated in patients with end-stage renal disease (ESRD), the current Centers for Disease Control and Prevention (CDC) guidelines recommend cautious prescribing of opioids. However, less data exists on the outcomes associated with prescription opioid use in patients with ESRD.
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For their study, the researchers assessed opioid prescriptions and doses among 671,281 patients on maintenance dialysis, of whom 271,285 were unique patients. All patients had Medicare Part A, B, or D coverage during each study year. Patient data was obtained via the 2006-2010 US Renal Data System.

Part D prescription claims were used to confirm opioid prescriptions. Associations of opioid prescription with subsequent all-cause mortality, discontinuation of dialysis, and hospitalization were assessed in participants in the 2010 prevalent cohort (n = 153,758). Factors including demographics, comorbidity, modality, and residence were also taken into account.

The researchers found that more than 60% of study participants had received at least 1 opioid prescription per year and that about 20% of patients had a chronic opioid prescription (a supply lasting 90 days or more) per year, usually for hydrocodone, oxycodone, or tramadol in 2010.

The risk for mortality, discontinuation of dialysis, and hospitalization was higher among participants in the 2010 cohort with short-term (a supply lasting 1 to 89 days) and chronic opioid prescriptions vs participants without an opioid prescription. All opioid drugs had been associated with a higher risk for mortality, and most were also associated with worsened morbidity. Furthermore, higher doses of opioids were associated with the risk for mortality in a monotonically increasing manner.

“We conclude that opioid drug prescription is associated with increased risk of death, dialysis discontinuation, and hospitalization in dialysis patients,” the researchers concluded. “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.”

—Christina Vogt

Reference:

Kimmel PL, Fwu CW, Abbott KC, Eggers AW, Kline PP, Eggers PW. Opioid prescription, morbidity, and mortality in United States dialysis patients [Published online September 21, 2017]. J Am Soc Nephrol. doi:10.1681/ASN.2017010098.