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Kidney Week

Abstract: FR-PO232

Is the Use of Opioids and Benzodiazepines Among Patients with CKD Stages 3-5 Associated with Postoperative Outcome?

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Long, Thorir E., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Helgason, Dadi, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Sigurdsson, Martin I., Duke University Medical Center, Durham, North Carolina, United States
  • Sigurdsson, Gisli H., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Palsson, Runolfur, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Indridason, Olafur S., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
Background

Preoperative use of opioids and benzodiazepines (BZDs) has been associated with adverse outcomes following surgery. The aim of this study was to examine the use of opioids and BZDs among individuals with chronic kidney disease (CKD) in association with postoperative outcomes.

Methods

This was a retrospective study of adult patients who underwent non-cardiac surgery at the University Hospital in Reykjavik in 2006-2015. Clinical data was obtained from electronic medical records. CKD stages 3-5 was defined according the the KDIGO classification system. Patients were considered to be using opioids or BZDs if they had filled a prescription within six months prior to surgery and a daily defined dose (DDD) was determined for all patients. Survival of CKD patients using opioids and BZD was compared to propensity score-matched (PSM, 1:1) control group of CKD patients not using these medications.

Results

A total of 42,600 patients underwent non-cardiac surgery during the 10-year study period, of whom 6973 (16.4%) had preoperative CKD 3-5, with 3877 (9.1%), 1845 (4.3%), 578 (1.4%) and 673 (1.6%) having stages 3A, 3B, 4 and 5, respectively. Preoperatively there were 8008 (19%), 3327 (8%), 2888 (7%) individuals taking opioids, BZDs and both opioids and BZDs, respectively. CKD patients were more often treated with BZDs (10.5% vs. 7.3%) and both opioids and BZDs (8.6% vs. 6.4%) than patients without CKD (p<0.001). CKD patients received a median (interquartile range, IQR) of 47 (20-112) DDD of opioids and BZDs over the 6 month period, compared with 33 (13-93) DDD in those without CKD (p<0.001). Preoperative use of opioids or BDZs among CKD patients was not associated with worse 30-day (97% vs. 96%, p=0.1) or one-year survival (86% vs. 86%, p=0.66) compared to the PSM control group. In an analysis limited to individuals with CKD stage 3B or higher, who were prescribed >90 DDD in the six months preoperatively, 30-day (96% vs. 97%) and one-year survival (84% vs. 84%) was similar to controls.

Conclusion

In this surgical cohort we found that patients with CKD were more commonly prescribed opioids, BZDs or both, but quantity of prescribed medications was modest. With this prescription pattern, adverse effect on postoperative survival was not observed.

Funding

  • Government Support - Non-U.S.