Abstract: TH-PO1073
Comparative Effectiveness of Opioids vs. Non-Opioid Analgesics on the Risk of ESRD and Mortality Among US Veterans with CKD and Chronic Pain
Session Information
- CKD Progression and Complications: Diagnosis, Prognosis, Risk Factors
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Surbhi, Satya, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Mallisetty, Yamini, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Shrestha, Prabin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
- Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background
Pain is common among individuals with CKD, in whom commonly used analgesics such as NSAIDs are often contraindicated. Opioids can be an alternative, but they are associated with unwanted adverse effects, leaving patients with few choices for analgesia. Non-opioid non-NSAID analgesics (e.g., gabapentin, acetaminophen, antipyrine) represent potential alternative choices, but their long-term outcomes in CKD. We compared the association of chronic opioid vs. non-opioid analgesics with end-stage kidney disease (ESKD) and all-cause mortality among patients with CKD and chronic pain.
Methods
We examined patients with CKD (defined as two or more eGFR <60 or UACR >30) and chronic pain (defined as 2 or more pain scores >7, 90 to 365 days apart). Chronic opioid and non-opioid analgesic use was defined as at least one 30-day supply in the one-year period following the second pain score. The association of opioid vs. non-opioid use with ESKD and mortality was examined using Kaplan-Meier estimates and multivariable adjusted Cox proportional hazards models.
Results
The total sample included 16,494 patients, of which 13,631 (82.6%) used non-opioid and 2,863 (17.4%) used opioid analgesics. Overall, patients were 69.1±11.7 years old, 96% were men, and 19% were African American, with a mean baseline eGFR of 66±22 and with 38% with UACR of >30. Opioid use (vs. non-opioid use) was associated with significantly higher risk of mortality, but not with the incidence of ESKD (Table).
Conclusion
The use of opioid analgesics was associated with higher risk of mortality among patients with CKD and chronic pain. Additional studies are needed to examine whether non-opioid analgesics could be considered as safer agents for chronic pain management among patients with CKD.
Multivariable Adjusted Cox Proportional Hazards Models to Compare the Association of Chronic Opioid vs. Non-Opioid Analgesics with ESKD and All-Cause Mortality among Patients with CKD and Chronic Pain
| Mortality Adjusted HR [95% CI] | ESKD Adjusted HR [95% CI] | |
| Model 1: Unadjusted | 1.42 (1.34,1.50) | 1.23 (0.98,1.53) |
| Model 2: Model 1+Demographic factors | 1.34 (1.27,1.42) | 1.32 (1.05,1.66) |
| Model 3: Model 2+Smoking+BMI+comorbidities | 1.21 (1.14,1.29) | 1.08 (0.83,1.40) |
| Model 4: Model 3+income+insurance | 1.19 (1.12,1.28) | 1.08 (0.81,1.43) |
| Model 5: Model 4+egfr+uacr | 1.22 (1.13,1.31) | 1.00 (0.67,1.50) |
Funding
- Veterans Affairs Support