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Abstract: TH-OR095

Opioid and Benzodiazepines Use in Patients on Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ruchi, Rupam, University of Florida, Gainesville, Florida, United States
  • Bozorgmehri, Shahab, University of Florida, Gainesville, Florida, United States
  • Ozrazgat-baslanti, Tezcan, University of Florida, Gainesville, Florida, United States
  • Segal, Mark S., University of Florida, Gainesville, Florida, United States
  • Kumar, Sanjeev, University of Florida, Gainesville, Florida, United States
Background

Opioid & Concomitant use of benzodiazepines is a public health problem. Little is known about opioids and benzodiazepine prescription in HD patients

Methods

This is retrospective study of USRDS data on ESRD patients ≥18 yrs, on HD, enrolled in Medicare & part D between 2006-2012, excluding those on PD & malignancy. We used ESRD Medicare Prescription Drug Events dataset for narcotics & benzodiazepines. We categorized narcotics into three safety classes per literature (safe, use caution, unsafe) and analyzed their prescription pattern. We used hospitalization dataset to identify hospitalization with opioid overdose using ICD-9 CM codes, total LOS and ICU LOS

Results

Out of 2,657,352 patients, 643,859 were included, & divided into opioid (n=480,460, 74.6%) and non-opioid group. The biggest difference b/w 2 groups is in the use of benzos (30% in opioid vs 11% in non-opioid P<0.001). There is significant association between opioid & benzo use (OR = 3.27, P<0.001). 6,665,906 narcotic prescriptions were written averaging 13.8 prescriptions/patient. 52.2% patients were prescribed narcotics/year. Each patient got an average of 8 prescriptions/year. 30% of patients who got a prescription for opioid, also got a prescription for a benzo. 56.5% received prescriptions for both within a week of each other.
Adverse events (A/E): 2225 patients with narcotic prescription (0.46%) had 3231 admissions with opioid overdose. 4 died. Median LOS is 4d, median ICU LOS is 2d. Benzo use prior to hospitalization was significantly higher in patients admitted for narcotic overdose as compared to others (40% vs 24%, p <0.001).
Association between opioid class and A/E: Among the "safe" drugs, fentanyl & hydromorphone were associated with moderately high odds of hospitalization within 30 days (OR 3 and 2.4 respectively) . This persisted at 60 & 90 days with fentanyl but decreased with hydromorphone at 90 days (1.6). Methadone was associated with a very high risk of hospitalization at 30 days (OR 5.9), that persisted at 60 & 90 days. Among the drugs to be used with caution hydrocodone had the least OR among all the drugs (1.8, 1.7 and 1.6 at 30, 60 and 90d). Oxycodone was moderate risk and oxymorphone (Opana) was high risk.

Conclusion

opioid and benzodiazpeine prescription in HD patients is very high. Drug safety based on pharmacokinetic profile in dialysis does not translate to clinical safety.