ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO659

Time Trends in Opioid Prescribing and Uncontrolled Pain in the Last Month of Life Among Patients with ESRD, 2010-2018

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

  • Wachterman, Melissa, Center for Healthcare Organization and Implementation Research, VA, Boston, Massachusetts, United States
  • O'Hare, Ann M., VA Puget Sound Health Care System, Seattle, Washington, United States
  • Keating, Nancy L., Harvard Medical School, Boston, Massachusetts, United States
  • Beilstein-Wedel, Erin, Center for Healthcare Organization and Implementation Research, VA, Boston, Massachusetts, United States
  • Meyer, Carly, Center for Healthcare Organization and Implementation Research, VA, Boston, Massachusetts, United States
  • Crowley, Susan T., Veterans Health Administration, West Haven, Connecticut, United States
Background

Most patients with ESRD experience frequent, uncontrolled pain near the end of life. Opioids have long been a core component of pain management near the end of life. In response to the opioid crisis, organizations including the Veterans Health Administration (VA) and the Centers for Disease Control have developed guidelines intended to reduce opioid overuse at the population level. Little is known about how these efforts may have impacted opioid prescribing and pain among patients with ESRD near the end of life.

Methods

Using data from the VA, we identified all 3,370 patients with ESRD who died in a VA facility between 2010-2018 whose next-of-kin completed the Bereaved Family Survey. Using survey and pharmacy data, we assessed the mean daily opioid dose (in morphine equivalents) and the proportion with proxy-reported frequent uncontrolled pain, both focused on the last month of life. We used generalized estimating equations to assess time trends in these two outcomes after adjustment for patient demographics and medical comorbidity.

Results

From 2010 to 2018 mean daily opioid dose in the last month of life (in morphine equivalents) decreased by 1.4 mg per year (p=.006) (see Figure for mean doses by year). From 2010 to 2018 the percentage of patients with frequent, uncontrolled pain in the last month of life increased by 1.9% per year (p<.001) (see Figure for percentages by year). These differences persisted after adjustment for patient characteristics.

Conclusion

Decreases in opioid prescribing among patients with ESRD over the last decade have been accompanied by increases in uncontrolled pain near the end of life, highlighting potential unintended consequences of opioid safety initiatives.

Funding

  • Other NIH Support