Abstract: TH-PO540

Use of Analgesics among Older Patients with CKD in the United States (2006-2015)

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Han, Yun, University of Michigan, Ann Arbor, Michigan, United States
  • Balkrishnan, Rajesh, University of Virginia School of Medicine, Charlottesville, Virginia, United States
  • He, Kevin, Kidney Epidemiology and Cost Center, University of Michgian, Ann Arbor, Michigan, United States
  • Hutton, David W., Kidney Epidemiology and Cost Center, University of Michgian, Ann Arbor, Michigan, United States
  • Steffick, Diane, University of Michigan, Ann Arbor, Michigan, United States
  • Hirth, Richard A., Kidney Epidemiology and Cost Center, University of Michgian, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
Background

Pain is common among patients with kidney disease yet few studies examine this, especially among older patients with non-dialysis CKD. We investigated US national trends in the use of nonsteroidal anti-inflammatory agents (NSAIDs) and opioid analgesics by older CKD patients over the past decade.

Methods

We identified eligible CKD patients enrolled in Medicare Part D through claims data (5% Medicare sample, 2006-2015). Demographics, CKD stages and comorbidities were assessed over a one-year entry period. Analgesic use by year was measured as the proportion of patients prescribed non-steroidal and opiate analgesics. The days-prescribed-per-user (DPPU) during a given calendar year were computed from medication claims. Logistic regression was used to explore factors associated with use of specific analgesics.

Results

There was a notable increase in use of NSAIDs among Medicare CKD patients in the past decade, from 10.5% in 2007 to a peak of 16.3% in 2011, with a decline to 14.3% in 2015 (Figure). DPPU were relatively stable, ranging from 104-109 days. NSAID use was consistently lower at higher stages of CKD. Opiates were prescribed to 39.4% of CKD patients in 2007, peaking at 48.3% in 2011 before declining to 44.6% in 2015 (Figure). Unlike NSAIDs, opioid use was highest in Stage 4-5 CKD. There was a significant increase in days prescribed in all CKD stages (30%-33%), from 89-104 to 116-138 per year. Younger age, female sex, not receiving the Part D subsidy, comorbid hypertension and diabetes were predictors of analgesic use in CKD patients. Opioids were more likely to be used by CKD patients who were white, or had higher stages of CKD, cancer or coronary artery disease.

Conclusion

Use of analgesics, particularly opioids, is very high in the Medicare CKD population, and rose substantially between 2007 and 2011. This study suggests both a high burden of pain in this vulnerable population, and the potential for suboptimal pain management and dangerous adverse effects, including narcotic dependence.

Proportion of Analgesic Use in Medicare Patients by CKD Stages

Funding

  • NIDDK Support