Kidney Week

Abstract: FR-OR118

Trends in Use of Prescription Opioids by Those with CKD in the United States, 1999 to 2014

Session Information

• Towards Better Medication Usage in Patients with CKD
  October 26, 2018 | Location: 26A, San Diego Convention Center
  Abstract Time: 05:42 PM - 05:54 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Murphy, Daniel P., University of Minnesota, Minneapolis, Minnesota, United States

Daniel P. Murphy, MD

• Foley, Robert N., University of Minnesota, Minneapolis, Minnesota, United States

Robert N. Foley,

Background

High rates of opioid prescribing in the United States have contributed to a national opioid epidemic. Those with chronic kidney disease (CKD) likely have not been immune, and may, in fact, have an increased probability of opioid prescription due to a high prevalence of pain and frequent contact with healthcare systems. We sought to elucidate trends in prescription opioid use in the CKD population over time, by levels of kidney function, and among CKD-relevant subgroups.

Methods

We examined trends in prescription opioid use from years 1999-2014 among adult National Health and Nutrition Examination Survey participants with creatinine-based estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m² or albumin-creatinine ratio (ACR) ≥ 30 mg/g. Differences in opioid use by racial/ethnic and other demographic characteristics and CKD-relevant comorbidities were described.

Results

7.5% of the CKD population used a prescription opioid compared to 5.4% among those without CKD (P < 0.001). Both reduced eGFR and albuminuria were associated with opioid use: 8.4% among those with eGFR < 60 ml/min/1.73m² compared to 5.6% (P < 0.001) among those without reduced eGFR, and 7.4% among those with ACR ≥ 30 mg/g compared to 5.6% (P < 0.001) among those without albuminuria. No temporal trend in unadjusted prevalence of opioid use in the CKD population was seen. In an age, sex, and race/ethnicity adjusted model, the most recent era 2011-2014 vs. 1999-2002 was associated with increased opioid use in the CKD population (adjusted odds ratio 1.43, 95% CI 1.05-1.95). Other multivariate associations (P < 0.05) were age 40-64 years, female sex, diabetes mellitus, hypertension, BMI ≥ 30 kg/m², history of cancer, and arthritis. After statistical adjustment, no difference was seen among racial/ethnic minorities in the CKD population.

Conclusion

Prescription opioid use is more prevalent among the CKD population than in the general U.S. population with 28% of opioid use among those with CKD attributable to the association with CKD. Multiple comorbidities, which to varying degrees increase risk for pain and/or exposure to healthcare systems, were associated with increased prevalence of prescription opioid use.