Abstract: SA-PO898
Associations of Opiate Use and Mortality Risk by Estimated Glomerular Filtration Rate in the NHANES Cohort
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
- Batcheller, Emily N., Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
- Benson-Hernandez, Taryn B., Harold Simmons Center, Bishop, California, United States
- Fitt, Rachel Hope, BUHS, Big Pine, California, United States
- Rhee, Connie, University of California Irvine, Huntington Beach, California, United States
- Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
Background
A previous study from the National Health and Nutrition Examination Survey (NHANES) cohort revealed that adults with chronic kidney disease (CKD) had a higher likelihood of having an active prescription for opioid medication. Although it is known that opioids are associated with a higher mortality risk, it is unknown if that risk differs according to estimated glomerular filtration rate (eGFR) or CKD stage. We sought to examine the association of opioid use with mortality risk across eGFR in the NHANES cohort.
Methods
We examined associations of opioid use with mortality risk in 42,041 NHANES adult participants between 1999-2014 using Cox proportional hazards models with adjustment for demographics, body mass index, serum albumin and indicators of comorbid conditions such as cancer, diabetes, and hypertension. eGFR was estimated from serum creatinine using the CKD-EPI equation. Data on mortality up to year 2015 were downloaded from the corresponding CDC website. Effect modification by continuous eGFR using restricted cubic splines were modeled.
Results
The mean±SD age of the cohort was 47±19 years and was comprised of 52% females and 21% non-Hispanic black patients. Patients reporting opioid use were slightly older and were more likely to have a lower eGFR or eGFR<60 mL/min/1.73m2. Overall opioid use was associated with a 27% higher risk of mortality in fully adjusted models (HR: 1.27, 95%CI: 1.13, 1.32). Hazard Ratios for eGFR 90+, 60-<90, and <60 were [HR:1.47, 95%CI: 1.20, 1.81; HR:1.32, 95%CI: 1.11, 1.58; HR: 1.06, 95%CI: 0.87, 1.29], respectively in fully adjusted models (p-for interaction eGFR-category and opioid use: p=0.067). In both unadjusted and adjusted models, restricted cubic splines show that the risk estimates of opioid use with mortality risk decline with lower GFR [figure].
Conclusion
In the NHANES cohort, mortality risk with opioid use appears to decline with lower eGFR or worsening CKD. Further studies should investigate these relationships in larger CKD cohorts with the ability to address potential confounding by indication, and impact of opioid dose, and opioid type.