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Abstract: SA-PO1063

Concomitant Prescription of Gabapentinoids and Opioids Predicts Mortality and Morbidity Among US Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Waddy, Salina Paulette, Atlanta Veterans Administration, Washington, District of Columbia, United States
  • Becerra, Adan Z., Social & Scientific Systems, Inc., Durham, North Carolina, United States
  • Ward, Julia B., Social & Scientific Systems, Inc., Durham, North Carolina, United States
  • Chan, Kevin, National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Fwu, Chyng-Wen, Social & Scientific Systems, Inc., Durham, North Carolina, United States
  • Eggers, Paul, National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Abbott, Kevin C., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
Background

The opioid epidemic is a public health emergency and appropriate prescription of medications for pain symptom management remains a challenge. Increasingly, providers prescribe gabapentenoids (gabapentin and pregabalin) for pain despite limited evidence to support their off-label use and reports of abuse in combination with opioids. We sought to estimate the prevalence of concomitant gabapentenoid and opioid prescriptions and evaluate the effect of concomitant prescriptions on morbidity and mortality among end-stage renal disease (ESRD) patients in the US.

Methods

We used the United States Renal Data System to identify ESRD patients who were continuously treated with dialysis and had part A, B, and D coverage for all of 2010. Part D filled prescription claims were used to identify whether each patient had filled a prescription for opioids, gabapentin, and pregabalin in 2010. Patients were followed for all-cause death, discontinuation of dialysis, and hospitalizations.

Results

The study population included 153,758 ESRD patients who met inclusion criteria. Concomitant prescription of an opioid and gabapentin (15%) was more common than concomitant prescription of an opioid and pregabalin (4%). In adjusted analyses using Cox models, concomitant prescription of an opioid and gabapentin was associated with increased risk of death (HR=1.16, 95% CI= 1.12, 1.19), dialysis discontinuation (HR=1.14, 95% CI= 1.03, 1.27), and hospitalization (HR=1.33, 95% CI= 1.41, 1.53). Similarly, concomitant prescription of an opioid and pregabalin was associated with increased mortality (HR=1.22, 95% CI= 1.16, 1.28) and hospitalization (HR=1.37, 95% CI= 1.33, 1.41), but not dialysis discontinuation (HR=1.13, 95% CI= 0.95, 1.35).

Conclusion

Concomitant prescription of opioids and gabapentenoids among US dialysis patients is common and is associated with worse outcomes. We were unable to identify the reasons why drugs were prescribed. The mechanisms underlying adverse effects are unclear, but prescription of gabapentenoids may be a marker for a sicker patient. Future research should investigate the potential harms of concomitant use of these drugs prospectively and identify safe alternatives for pain symptom management.