Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients
Copyright © 2018 by the American Society of Nephrology..
BACKGROUND AND OBJECTIVES: Patients on hemodialysis frequently experience pain and may be particularly vulnerable to opioid-related complications. However, data evaluating the risks of opioid use in patients on hemodialysis are limited.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the US Renal Data System, we conducted a cohort study evaluating the association between opioid use (modeled as a time-varying exposure and expressed in standardized oral morphine equivalents) and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture among 140,899 Medicare-covered adults receiving hemodialysis in 2011. We evaluated risk according to average daily total opioid dose (>60 mg, ≤60 mg, and per 60-mg dose increment) and specific agents (per 60-mg dose increment).
RESULTS: The median age was 61 years old, 52% were men, and 50% were white. Sixty-four percent received opioids, and 17% had an episode of altered mental status (15,658 events), fall (7646 events), or fracture (4151 events) in 2011. Opioid use was associated with risk for all outcomes in a dose-dependent manner: altered mental status (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.23 to 1.34; higher dose: hazard ratio, 1.67; 95% confidence interval, 1.56 to 1.78; hazard ratio, 1.29 per 60 mg; 95% confidence interval, 1.26 to 1.33), fall (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.21 to 1.36; higher dose: hazard ratio, 1.45; 95% confidence interval, 1.31 to 1.61; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.03 to 1.05), and fracture (lower dose: hazard ratio, 1.44; 95% confidence interval, 1.33 to 1.56; higher dose: hazard ratio, 1.65; 95% confidence interval, 1.44 to 1.89; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.04 to 1.05). All agents were associated with a significantly higher hazard of altered mental status, and several agents were associated with a significantly higher hazard of fall and fracture.
CONCLUSIONS: Opioids were associated with adverse outcomes in patients on hemodialysis, and this risk was present even at lower dosing and for agents that guidelines have recommended for use.
| Errataetall: |
CommentIn: Clin J Am Soc Nephrol. 2018 May 7;13(5):675-676. - PMID 29674339 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2018 |
|---|---|
| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
|---|---|
| Enthalten in: |
Clinical journal of the American Society of Nephrology : CJASN - 13(2018), 5 vom: 07. Mai, Seite 746-753 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Ishida, Julie H [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 13.11.2019 Date Revised 15.08.2023 published: Print-Electronic CommentIn: Clin J Am Soc Nephrol. 2018 May 7;13(5):675-676. - PMID 29674339 Citation Status MEDLINE |
|---|
| doi: |
10.2215/CJN.09910917 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM283223898 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM283223898 | ||
| 003 | DE-627 | ||
| 005 | 20231225040042.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2018 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.2215/CJN.09910917 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0944.xml |
| 035 | |a (DE-627)NLM283223898 | ||
| 035 | |a (NLM)29674340 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Ishida, Julie H |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| 264 | 1 | |c 2018 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 13.11.2019 | ||
| 500 | |a Date Revised 15.08.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Clin J Am Soc Nephrol. 2018 May 7;13(5):675-676. - PMID 29674339 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2018 by the American Society of Nephrology. | ||
| 520 | |a BACKGROUND AND OBJECTIVES: Patients on hemodialysis frequently experience pain and may be particularly vulnerable to opioid-related complications. However, data evaluating the risks of opioid use in patients on hemodialysis are limited | ||
| 520 | |a DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the US Renal Data System, we conducted a cohort study evaluating the association between opioid use (modeled as a time-varying exposure and expressed in standardized oral morphine equivalents) and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture among 140,899 Medicare-covered adults receiving hemodialysis in 2011. We evaluated risk according to average daily total opioid dose (>60 mg, ≤60 mg, and per 60-mg dose increment) and specific agents (per 60-mg dose increment) | ||
| 520 | |a RESULTS: The median age was 61 years old, 52% were men, and 50% were white. Sixty-four percent received opioids, and 17% had an episode of altered mental status (15,658 events), fall (7646 events), or fracture (4151 events) in 2011. Opioid use was associated with risk for all outcomes in a dose-dependent manner: altered mental status (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.23 to 1.34; higher dose: hazard ratio, 1.67; 95% confidence interval, 1.56 to 1.78; hazard ratio, 1.29 per 60 mg; 95% confidence interval, 1.26 to 1.33), fall (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.21 to 1.36; higher dose: hazard ratio, 1.45; 95% confidence interval, 1.31 to 1.61; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.03 to 1.05), and fracture (lower dose: hazard ratio, 1.44; 95% confidence interval, 1.33 to 1.56; higher dose: hazard ratio, 1.65; 95% confidence interval, 1.44 to 1.89; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.04 to 1.05). All agents were associated with a significantly higher hazard of altered mental status, and several agents were associated with a significantly higher hazard of fall and fracture | ||
| 520 | |a CONCLUSIONS: Opioids were associated with adverse outcomes in patients on hemodialysis, and this risk was present even at lower dosing and for agents that guidelines have recommended for use | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Analgesics, Opioid | |
| 650 | 4 | |a Cohort Studies | |
| 650 | 4 | |a Emergency Service, Hospital | |
| 650 | 4 | |a Humans | |
| 650 | 4 | |a Medicare | |
| 650 | 4 | |a Middle Aged | |
| 650 | 4 | |a Morphine | |
| 650 | 4 | |a Opioid-Related Disorders | |
| 650 | 4 | |a Pain | |
| 650 | 4 | |a United States | |
| 650 | 4 | |a United States Renal Data System | |
| 650 | 4 | |a clinical epidemiology | |
| 650 | 4 | |a hemodialysis | |
| 650 | 4 | |a hospitalization | |
| 650 | 4 | |a opioid | |
| 650 | 4 | |a renal dialysis | |
| 650 | 7 | |a Analgesics, Opioid |2 NLM | |
| 700 | 1 | |a McCulloch, Charles E |e verfasserin |4 aut | |
| 700 | 1 | |a Steinman, Michael A |e verfasserin |4 aut | |
| 700 | 1 | |a Grimes, Barbara A |e verfasserin |4 aut | |
| 700 | 1 | |a Johansen, Kirsten L |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Clinical journal of the American Society of Nephrology : CJASN |d 2006 |g 13(2018), 5 vom: 07. Mai, Seite 746-753 |w (DE-627)NLM172123720 |x 1555-905X |7 nnns |
| 773 | 1 | 8 | |g volume:13 |g year:2018 |g number:5 |g day:07 |g month:05 |g pages:746-753 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.2215/CJN.09910917 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 13 |j 2018 |e 5 |b 07 |c 05 |h 746-753 | ||