Kidney Week

Abstract: TH-PO1164

Use of Opioids and Nonsteroidal Anti-Inflammatory Drugs in Living Kidney Donors: Clinical Correlates and Early Outcomes

Session Information

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

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States

Krista L. Lentine,

• Vest, Luke S., Saint Louis University, St. Louis, Missouri, United States

Luke S. Vest,

• Sarabu, Nagaraju, Cleveland Med Center, Cleveland, Ohio, United States

Nagaraju Sarabu,

• Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada

Ngan Lam,

• Koraishy, Farrukh M., Saint Louis University, St. Louis, Missouri, United States

Farrukh M. Koraishy,

• Schnitzler, Mark, Saint Louis Univ, Shiloh, Illinois, United States

Mark Schnitzler,

Background

Limited data are available on pain medication use in living kidney donors (LKD). While there is growing national concern related to opioids, there is also concern for non-steroidal anti-inflammatory (NSAID) use due to potential nephrotoxicity.

Methods

We examined a novel database wherein national LKD registry identifiers were linked to records from a large U.S. pharmaceutical claims warehouse (2007 to 2017 fills). We selected LKD with 1 year of postdonation pharmaceutical fill records. Associations of baseline demographic and clinical factors with opioid and NSAID use (adjusted odds ratio, 95% _LCL aHR 95% _UCL) were quantified by multivariate logistic regression.

Results

Among 23,564 eligible LKD, opioid use declined postdonation: 36.6%, mos. >0-0.5; 14.7%, mos. 0.6-6; 12.6%, mos. 7-12. NSAID use was uncommon, but increased: 0.5%, mos. >0-0.5; 2.2%, mos. 0.6-6; 3.3%, mos. 7-12. With adjustment including predonation estimated glomerular filtration rate, hypertension, donor-recipient relationship and nephrectomy type, opioid use in mos. 7-12 was associated (P<0.05) with female sex (_1.131.24_1.35), black race (_1.031.17_1.32), obesity (_1.241.38_1.53), lower education (_1.191.31_1.43), not working (_1.021.12_1.24), smoking (_1.331.45_1.58), and surgical complications (_1.111.29_1.49) (Fig.). NSAID use was more common in women, black and Hispanic LKD, obese LKD, those with lower education, not working, and with surgical complications. Patterns were similar in earlier postdonation periods. Neither opioids nor NSAIDs were associated with eGFR change or proteinuria to 2 years

Conclusion

Opioid and NSAID use in LKD vary with demographic and clinical traits. Work is needed to define safety and optimal choice of pain medications in LKD.

Fig 1. Associations of baseline traits with pain medication use