Kidney Week

Abstract: SA-PO895

Association Between Pre-ESRD Opioid Use and Post-ESRD Mortality

Session Information

• CKD: Pharmacoepidemiology
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Praveen Kumar Potukuchi,

• Sumida, Keiichi, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Keiichi Sumida,

• Spivey, Christina Alease, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Christina Alease Spivey,

• Dashputre, Ankur A., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Ankur A. Dashputre,

• Gaipov, Abduzhappar, National Scientific Medical Center, Astana, Kazakhstan

Abduzhappar Gaipov,

• Kar, Suryatapa, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Suryatapa Kar,

• Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Fridtjof Thomas,

• Gatwood, Justin, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Justin Gatwood,

• Obi, Yoshitsugu, University of California Irvine, Irvine, California, United States

Yoshitsugu Obi,

• Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Miklos Zsolt Molnar,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Elani Streja,

• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Chisholm-Burns, Marie, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, United States

Marie Chisholm-Burns,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

Background

Opioids are frequently used for chronic pain management in patients with advanced CKD. The relationship between pre-ESRD opioid use and post-ESRD mortality is unclear.

Methods

In a national cohort of 69,765 US veterans who transitioned to dialysis during 2007-2014 we assessed the association between pre-ESRD opioid use and post-ESRD all-cause mortality. Opioid use was defined as receiving opioids within a year prior to dialysis initiation (N=31,472) and divided into four groups based on the cumulative received dose, expressed as annual morphine milligram equivalent (AMME): >0-300 mg (N=25,282), 301-600 mg (N=2,499), 601-1000 mg (N=993) and >1000mg (N=2,698). Associations were examined using Cox proportional hazards models adjusted for demographics, smoking status, comorbidities, nephrology care, number of outpatient visits, and cumulative length of hospitalizations.

Results

The mean (SD) age of the cohort was 71 (12) years, 93% were male, 24% were African American, and 64% had diabetes. Opioid users (AMME >300 mg) displayed significantly higher mortality compared to non-users [Figure]. The multivariable adjusted hazard ratios (95%CI) associated with the four incrementally higher AMME categories (vs. no opioid use) were 0.95 (0.93-0.97), 1.17 (1.12-1.23), 1.14 (1.06-1.23), and 1.17 (1.11-1.23), respectively.

Conclusion

Pre-ESRD opioid use was associated with higher post-ESRD mortality in patients with AMME >300 mg. Further studies are needed to determine whether this association is confounded by indication or whether part of the increased risk can be mitigated.

Funding

• NIDDK Support