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Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients
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| Zeitschriftentitel: | Clinical Journal of the American Society of Nephrology |
|---|---|
| Personen und Körperschaften: | , , , , |
| In: | Clinical Journal of the American Society of Nephrology, 13, 2018, 5, S. 746-753 |
| Format: | E-Article |
| Sprache: | Englisch |
| veröffentlicht: |
Ovid Technologies (Wolters Kluwer Health)
|
| Schlagwörter: |
| author_facet |
Ishida, Julie H. McCulloch, Charles E. Steinman, Michael A. Grimes, Barbara A. Johansen, Kirsten L. Ishida, Julie H. McCulloch, Charles E. Steinman, Michael A. Grimes, Barbara A. Johansen, Kirsten L. |
|---|---|
| author |
Ishida, Julie H. McCulloch, Charles E. Steinman, Michael A. Grimes, Barbara A. Johansen, Kirsten L. |
| spellingShingle |
Ishida, Julie H. McCulloch, Charles E. Steinman, Michael A. Grimes, Barbara A. Johansen, Kirsten L. Clinical Journal of the American Society of Nephrology Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients Transplantation Nephrology Critical Care and Intensive Care Medicine Epidemiology |
| author_sort |
ishida, julie h. |
| spelling |
Ishida, Julie H. McCulloch, Charles E. Steinman, Michael A. Grimes, Barbara A. Johansen, Kirsten L. 1555-9041 1555-905X Ovid Technologies (Wolters Kluwer Health) Transplantation Nephrology Critical Care and Intensive Care Medicine Epidemiology http://dx.doi.org/10.2215/cjn.09910917 <jats:sec> <jats:title>Background and objectives</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Design, setting, participants, & measurements</jats:title> <jats:p>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).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> </jats:sec> Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients Clinical Journal of the American Society of Nephrology |
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Clinical Journal of the American Society of Nephrology |
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| title |
Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| title_unstemmed |
Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| title_full |
Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| title_fullStr |
Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| title_full_unstemmed |
Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| title_short |
Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| title_sort |
opioid analgesics and adverse outcomes among hemodialysis patients |
| topic |
Transplantation Nephrology Critical Care and Intensive Care Medicine Epidemiology |
| url |
http://dx.doi.org/10.2215/cjn.09910917 |
| publishDate |
2018 |
| physical |
746-753 |
| description |
<jats:sec>
<jats:title>Background and objectives</jats:title>
<jats:p>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.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Design, setting, participants, & measurements</jats:title>
<jats:p>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).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>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.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>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.</jats:p>
</jats:sec> |
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| author | Ishida, Julie H., McCulloch, Charles E., Steinman, Michael A., Grimes, Barbara A., Johansen, Kirsten L. |
| author_facet | Ishida, Julie H., McCulloch, Charles E., Steinman, Michael A., Grimes, Barbara A., Johansen, Kirsten L., Ishida, Julie H., McCulloch, Charles E., Steinman, Michael A., Grimes, Barbara A., Johansen, Kirsten L. |
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| description | <jats:sec> <jats:title>Background and objectives</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Design, setting, participants, & measurements</jats:title> <jats:p>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).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> </jats:sec> |
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| spelling | Ishida, Julie H. McCulloch, Charles E. Steinman, Michael A. Grimes, Barbara A. Johansen, Kirsten L. 1555-9041 1555-905X Ovid Technologies (Wolters Kluwer Health) Transplantation Nephrology Critical Care and Intensive Care Medicine Epidemiology http://dx.doi.org/10.2215/cjn.09910917 <jats:sec> <jats:title>Background and objectives</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Design, setting, participants, & measurements</jats:title> <jats:p>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).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> </jats:sec> Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients Clinical Journal of the American Society of Nephrology |
| spellingShingle | Ishida, Julie H., McCulloch, Charles E., Steinman, Michael A., Grimes, Barbara A., Johansen, Kirsten L., Clinical Journal of the American Society of Nephrology, Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients, Transplantation, Nephrology, Critical Care and Intensive Care Medicine, Epidemiology |
| title | Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| title_full | Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| title_fullStr | Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| title_full_unstemmed | Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| title_short | Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| title_sort | opioid analgesics and adverse outcomes among hemodialysis patients |
| title_unstemmed | Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients |
| topic | Transplantation, Nephrology, Critical Care and Intensive Care Medicine, Epidemiology |
| url | http://dx.doi.org/10.2215/cjn.09910917 |