• From 2006 to 2010, almost two thirds of US dialysis patients received at least one opioid prescription every year and >20% received chronic prescriptions.
  • More than 25% of dialysis patients using opioids received doses exceeding recommendations
  • Use of opioid medications was linked with higher risks of early death, discontinuation of dialysis, and the need for hospitalization in dialysis patients.

In 2016, the Centers for Disease Control and Prevention released a clinical guideline for prescribing opioids for chronic pain.

Newswise — Washington, DC (September 21, 2017) — A new analysis indicates that the US opioid epidemic likely applies to the unique population of dialysis patients. The study, which appears in an upcoming issue of the Journal of the American Society of Nephrology (JASN), also found links between higher opioid drug prescription and increased risks of dialysis discontinuation, hospitalization, and early death.

Pain is frequent in dialysis patients but pain control is difficult because many options should be avoided due to patients’ kidney failure. Chronic use of opioid pain medications is a significant risk factor for opioid overdose in the general US population, but the issue has not been examined in the dialysis population.

To investigate, Paul Kimmel, MD, MACP, FASN (National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health) and his colleagues assessed prescriptions of medications in US patients undergoing maintenance dialysis who had Medicare as their primary insurer. The team achieved this by analyzing 2006-2010 United States Renal Data System files, including those related to Medicare Part D.

Opioid medications were prescribed more frequently and for longer periods of time than in the general Medicare population, and often at high doses that are not recommended for patients with kidney failure. Almost two thirds of dialysis patients received at least one opioid prescription every year and >20% received chronic prescriptions (≥ 90 days of filled prescriptions), 3-times as great as the rate of chronic opioid prescription in the general Medicare population. More than one-quarter of opioid users received doses exceeding recommendations. Also, after adjusting for other factors, dialysis patients who received opioid medications were at significantly higher risk of early death, discontinuation of dialysis, and the need for hospitalization, compared with those who did not receive opioids. These adverse events were most common in those who received higher doses.

“Excessive opioid use and its adverse outcomes in the end-stage renal disease population is of great concern to US patients, practitioners, and policy makers,” said Dr. Kimmel. “This study shows that this high-risk dialysis population is also subject to the risks of long-term opioid use. Exploring other options to treat pain, such as medications and behavioral therapy, could help reduce opioid prescriptions in this population. Such changes are urgently needed to decrease patient morbidity and mortality.”

Study co-authors include Chyng-Wen Fwu, DrPH, Kevin Abbott, MD, MPH, Anne Eggers, RPH, Prudence Kline, MD, and Paul Eggers, PhD. Dr. Fwu is supported by NIDDK contract HHSN276201200161U. 

Disclosures: The authors reported no financial disclosures.

The article, entitled “Opioid Prescription, Morbidity and Mortality in US Dialysis Patients,” will appear online at http://jasn.asnjournals.org/ on September 21, 2017, doi: 10.1681/ASN.2017010098.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has nearly 17,000 members representing 112 countries. For more information, please visit www.asn-online.org or contact the society at 202-640-4660.

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The content in this release is the sole responsibility of the authors and does not necessarily represent the official views or imply endorsement of the National Institute of Diabetes and Digestive and Kidney Diseases or the National Institutes of Health.

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