Kidney Week

Abstract: FR-PO427

Decline in Opioid Prescriptions in US Dialysis and Kidney Transplant Patients, 2011-2020

Session Information

• Hemodialysis Epidemiology and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Kimmel, Paul L., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States

Paul L. Kimmel, MD, FASN

• Fwu, Chyng-Wen, Social and Scientific Systems, Inc., a DLH Holdings Corp (DLH) company, Silver Spring, Maryland, United States

Chyng-Wen Fwu, DrPH

• Nolin, Thomas D., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Thomas D. Nolin, PharmD, PhD, FASN

• Schulman, Ivonne Hernandez, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States

Ivonne Hernandez Schulman, MD, MA, FASN

• Givens-Bradley, Shannon Sharee, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States

Shannon Sharee Givens-Bradley, DHSc, MPH

• Wilkins, Kenneth J., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States

Kenneth J. Wilkins, PhD

• Mendley, Susan R., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States

Susan R. Mendley, MD

• Gipson, Debbie, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States

Debbie Gipson, MD, MS

• Greer, Raquel C., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States

Raquel C. Greer, MD

• Norton, Jenna M., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States

Jenna M. Norton, PhD, MPH

• Chan, Kevin L., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States

Kevin L. Chan, MD, MS, MSc

• Eggers, Paul, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States

Paul Eggers, PhD

Background

Pain is important for ESKD patients, but opioid medication (OM) prescriptions are associated with morbidity and mortality. The CDC issued OM prescription guidelines in 2016 and 2022, associated with dramatically decreased prescription rates in the U.S. population. It is critical to know if nationwide ESRD OM prescription rates have decreased.

Methods

We analyzed the USRDS database from 2011-2020 to describe trends in the proportion of ESRD dialysis and kidney transplant patients who received one or more, or chronic OM prescriptions, examined factors associated with chronic OM prescriptions, and evaluated associations of all-cause death with short-term or chronic OM prescriptions.

Results

From 2011-2022, the study population ranged between 202,000 and 240,000 patients. Dialysis patients decreased over the study from 80.4 to 76.8%. The percent of ESRD patients who received at least one or more, or who had received chronic OM prescriptions decreased steadily, from 60.4% to 42.1%, and from 22.6% to 13.0% (Table), respectively (both P for trend <0.001). The greatest reductions in prescription rates were for hydrocodone and oxycodone. Similar decreases existed for dialysis and kidney transplant patients. Women, the poor and those in rural settings were more likely to receive chronic OM prescriptions. Prescription rates were highest in White patients and those 45-64 years old. Short-term and chronic OM prescriptions were associated with increased mortality in both dialysis and kidney transplant patients.

Conclusion

ESRD patients’ OM prescription rates decreased between 2011 and 2020. Determining the risks and benefits of decreasing OM prescription doses in individual ESRD patients will require clinical judgment and shared decision-making between patients and providers to improve treatment of pain and outcomes.

Funding

• NIDDK Support