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Abstract: TH-OR096

Prevalence, Indications, and Risks of Muscle Relaxant Use among Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Mina, Diana, UCSF, San Francisco, California, United States
  • Johansen, Kirsten L., UCSF, San Francisco, California, United States
  • McCulloch, Charles E., UCSF, San Francisco, California, United States
  • Steinman, Michael, UCSF, San Francisco, California, United States
  • Grimes, Barbara A., UCSF, San Francisco, California, United States
  • Ishida, Julie H., UCSF, San Francisco, California, United States
Background

Muscle relaxants are used to treat musculoskeletal pain and cramping, which are commonly experienced symptoms among hemodialysis patients. However, epidemiologic data characterizing the prevalence, indications, and risks of muscle relaxant use in this population are lacking.

Methods

From the USRDS, we identified 140,899 adults receiving in-center hemodialysis with Medicare Part D in 2011. We determined the prevalence of muscle relaxant use and the presence of a relevant indication, defined by ICD-9 codes, within 60 days preceding the date of a prescription by examining Medicare claims data. Using Cox regression models, we investigated the association between receipt of muscle relaxants (e.g., cyclobenzaprine, baclofen), modeled as a time-varying exposure, and time to first emergency room visit or hospitalization for altered mental status (AMS), fall, and fracture defined by ICD-9 and CPT codes. We adjusted for demographics, comorbidities, duration of muscle relaxant exposure, number of medications, and concomitant medications. Exposure was time-lagged (i.e., ascertained from the prior day) for fall and fracture in order to account for possible effect/cause.

Results

Ten percent (14,312) of the cohort received muscle relaxants, and 17% (24,067) had an episode of AMS, fall, or fracture in 2011. The most common diagnoses associated with muscle relaxant use were musculoskeletal pain other than neck or back pain (72%), back pain (48%), and muscle spasticity (25%). Fourteen percent of patients with a muscle relaxant prescription lacked a relevant indication. Muscle relaxant use was significantly associated with AMS, fall, and fracture (Table).

Conclusion

Muscle relaxants are commonly used by hemodialysis patients. They were most frequently prescribed for musculoskeletal pain and spasticity, but a sizeable proportion of patients lacked a clear indication based on claims data. Muscle relaxants are associated with a high risk for AMS, fall, and fracture. Future research to define the appropriate use of these agents in this population is warranted.

Risk of Adverse Outcomes Associated with Muscle Relaxant Use
 Hazard Ratio (95% Confidence Interval)
 AMSFallFracture
None1.00 (ref)1.00 (ref)1.00 (ref)
Muscle Relaxant1.68 (1.53-1.84)1.29 (1.11-1.49)1.30 (1.05-1.61)

Funding

  • NIDDK Support