Kidney Week

Abstract: TH-PO298

Gabapentin Use and Adverse Effects among Hemodialysis Patients Diagnosed with Pruritus or Neuropathic Pain in US Claims Data

Session Information

• Hemodialysis and Frequent Dialysis - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Rigatto, Claudio, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Claudio Rigatto, MD, MS, MSc

• Lu, Ting, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Ting Lu

• Schaufler, Thilo, Vifor Pharma Management AG, Glattbrugg, Zurich, Switzerland

Thilo Schaufler, PhD

• Ruessmann, Despina, Vifor Pharma Management AG, Glattbrugg, Zurich, Switzerland

Despina Ruessmann, DrMed

• Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Ronald L. Pisoni, PhD

• Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Brian Bieber, MPH

• Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Angelo Karaboyas, MS, PhD

• Strupp, Michael, Ludwig-Maximilians-Universitat Munchen, Munchen, Bayern, Germany

Michael Strupp, DO

Background

Chronic kidney disease-associated pruritus (CKD-aP) is linked with numerous clinical and patient-reported outcomes. Gabapentin (Gaba) is indicated for neuropathic pain (NP), and also used off-label to reduce pruritus symptoms. There are, however, concerns about adverse events (AEs), namely altered mental status and risk of falls. We explored real-world Gaba utilization patterns and relevant AEs in US hemodialysis (HD) patients, and how they may differ by diagnosis of CKD-aP vs. NP.

Methods

We used claims data from 533,232 adult HD patients in the USRDS database between 2016-2020 with Fee-For-Service Medicare Part D coverage. Gaba use, dose, and time to discontinuation were stratified by time-updated diagnosis of CKD-aP or NP. The associations between time-varying Gaba dose – defined as current prescription updated continuously – and six AEs were analysed by recurrent event Andersen-Gill model and adjusted for potential confounders, separately by time-updated diagnosis of CKD-aP or NP.

Results

Point-prevalence of Gaba prescription was 13.9% overall, and was higher among patients with NP (21.1%) than with CKD-aP (11.0%). Median [IQR] time to discontinuation was 5.2 [2.0, 13.0] months in the NP group and 4.2 [1.5, 11.6] months in the CKD-aP group. Mean Gaba dose was higher (503 vs. 433 mg/day) in the NP vs. CKD-aP group, and increased during the first year of use from 410 to 494 mg/day. AE rates ranged from 9.3 (fracture) to 37.8 (altered mental status) per 100 patient-years. We observed a strong dose-response association between Gaba dose and AEs, particularly among patients with CKD-aP (Table).

Conclusion

Use of Gaba in HD patients was associated with a higher risk of AEs (including altered mental status, dizziness, falls, and fracture), even at doses as low as 100 mg/day. The increase was greater when Gaba was used off-label in CKD-aP patients. Prescribers should consider the clinically relevant side effects of Gaba when providing treatment options to their patients with CKD-aP.

Funding

• Commercial Support – Commercial support by Vifor Fresenius Medical Care Renal Pharma