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Please note that you are viewing an archived section from 2019 and some content may be unavailable. To unlock all content for 2019, please visit the archives.

Abstract: TH-PO658

Benzodiazepines, Opioids, and Mortality Among Hemodialysis Patients

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • McAdams-DeMarco, Mara, Johns Hopkins, Baltimore, Maryland, United States
  • Muzaale, Abimereki, Johns Hopkins University, Baltimore, Maryland, United States
  • Bae, Sunjae, Johns Hopkins, Baltimore, Maryland, United States
  • Chu, Nadia M., Johns Hopkins, Baltimore, Maryland, United States
  • Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States
  • Segev, Dorry L., Johns Hopkins, Baltimore, Maryland, United States
Background

Mortality from benzodiazepine/opioid interactions is a growing concern in light of the opioid epidemic. HD patients suffer from a high burden of conditions which are treated with benzodiazepines and are 3-times more likely to be prescribed opioids than the general population. Therefore, they are at risk of mortality resulting from benzodiazepine/opioid interactions.

Methods

A cohort of 110,127 adults initiating HD (1/2013-12/2014) was assembled by linking USRDS/Medicare claims. Using adjusted Cox regression, we estimated the mortality risk associated with benzodiazepine prescribing (time-varying) and tested whether this risk differed by opioid prescribing.

Results

Within 1 year of HD initiation, 17.3% were prescribed a short- and 5.5% were prescribed a long-acting benzodiazepine. Co-prescribing of opioids and short- (78.7%) and long-acting benzodiazepines (81.8%) were common. Opioid prescribing was associated with short- (aHR=2.07,95%CI:2.00-2.14) and long-acting benzodiazepine prescribing (aHR=2.30,95%CI:2.15-2.47). Patients prescribed a short-acting benzodiazepine were at 1.53-fold (95%CI:1.45-1.61) increased mortality risk; this risk was exacerbated to 1.78-fold (95%CI:1.63-1.94) increased mortality risk with opioid co-prescribing (pinteraction=0.01). In contrast, long-acting benzodiazepine prescribing was inversely associated with mortality (aHR=0.85,95%CI:0.75-0.96) and there was no differential risk by opioid prescribing (pinteraction=0.57).

Conclusion

Patients initiating HD are commonly co-prescribed short-acting benzodiazepines and opioids which was associated with a 1.8-fold increased mortality risk. High-risk co-prescribing of short-acting benzodiazepine/opioids should be recognized by physicians caring for this vulnerable population.

Funding

  • NIDDK Support