Kidney Week

Abstract: SA-PO617

Prevalence and Adverse Outcomes Associated with Opioid Prescriptions Across the Range of eGFR

Session Information

• Pharmacology
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

• 1700 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

Authors

• Novick, Tessa Kimberly, Johns Hopkins University, Baltimore, Maryland, United States

Tessa Kimberly Novick,

• Surapaneni, Aditya L., Johns Hopkins University, Baltimore, Maryland, United States

Aditya L. Surapaneni,

• Shin, Jung-Im, Johns Hopkins University, Baltimore, Maryland, United States

Jung-Im Shin,

• Alexander, G caleb, Johns Hopkins University, Baltimore, Maryland, United States

G caleb Alexander,

• Inker, Lesley, Tufts Medical Center, Boston, Massachusetts, United States

Lesley Inker,

• Chang, Alex R., Geisinger Medical Center, Danville, Pennsylvania, United States

Alex R. Chang,

• Grams, Morgan, Johns Hopkins University, Baltimore, Maryland, United States

Morgan Grams,

Background

Kidney disease limits therapeutic options for pain control given the relative contraindication to non-steroidal antiflammatory drugs. The goal of this study was to assess the prevalence and safety of prescription opioid use across the range of eGFR in a U.S. outpatient population.

Methods

Using electronic medical records from the Geisinger Health System, we described trends in opioid prescriptions by CKD stage between 2011 and 2016. In a cohort matched on propensity for ≥2 opioid prescriptions during a 2-year baseline period (2011-2013) we used Cox proportional hazards regression to evaluate the association between opiate prescription compared to no opiate prescription and death, total hospitalizations, non-pathologic fracture, and presentations for altered mental status, as well as whether associations differed by eGFR level.

Results

Opioid prescriptions increased over time, particularly among patients with eGFR < 30 ml/min/1.73m². For example, 43.5% patients with eGFR < 30 ml/min were prescribed opioids in 2011 compared to 46.4% in 2016 (p for trend < 0.001). Among 22,261 patients receiving at least two opiate prescriptions during the baseline period, a suitable match was found for 5,337 based on 23 clinical and demographic covariates. Patients with opioid prescriptions had significantly increased risk for death (HR 1.39, 95% CI 1.16-1.67), hospitalization (HR 1.51, 95% CI 1.39-1.63), and non-pathologic fracture (HR 1.51, 95% CI 1.33-1.72) compared to their counterparts for all levels of eGFR (p >0.05), but differences in altered mental status were not statistically significant (HR 1.22, 95% CI 0.79-1.88) (Figure).

Conclusion

Opioid prescriptions are common in patients with CKD and are associated with higher risk for death, hospital admissions and non-pathologic fracture.