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Abstract: PO1181

Comparative Risk of Fall-Related Fractures Among Hemodialysis Patients Newly Initiating Zolpidem vs. Trazodone Therapy

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Assimon, Magdalene M., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Flythe, Jennifer E., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Zolpidem, a non-benzodiazepine hypnotic, and trazodone, a sedating antidepressant, are the most common medications used to treat insomnia in the United States. Both drugs have side effects (e.g. drowsiness, dizziness, cognitive and motor impairment) that can increase the risk of falls and resultant fracture events. Despite widespread zolpidem and trazodone use, little is known about the comparative safety of these medications in hemodialysis patients, a vulnerable population with an exceedingly high fracture rate.


We conducted a retrospective cohort study using an active comparator new-user design to investigate the association between zolpidem vs. trazodone initiation and the 30-day risk of hospitalized fall-related fractures among Medicare-enrolled hemodialysis patients in the United States Renal Data System Registry (2013 – 2016). We used an intention-to-treat analytic approach and propensity score weighted survival models, adjusted for numerous demographic and clinical covariates, to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs). Death was treated as a competing event.


A total of 31,055 hemodialysis patients were included in the study, 18,941 zolpidem initiators (61%) and 12,114 trazodone initiators (39%). Newly initiating zolpidem vs. trazodone therapy was associated with a higher risk of hospitalized fall-related fractures, HR [95% CI] = 1.71 [1.11, 2.63]. The association was more pronounced among individuals prescribed higher zolpidem doses (1.92 [1.14, 3.21]) and in subgroups with fall-related risk factors, such as older and frailer patients (1.89 [1.14, 3.09] and 2.49 [1.31, 4.73], respectively) and individuals using other medications with central nervous system activity (2.04 [1.14, 3.67]). Sensitivity analyses using longer follow-up durations, evaluating a broader outcome (hospitalized fracture), and employing an on-treatment analytic approach yielded similar results (data not shown).


Hemodialysis patients newly initiating zolpidem had a higher risk of hospitalized fall-related fracture compared to patients initiating trazodone, suggesting that trazodone may be a safer pharmacologic treatment option for the management of insomnia in this vulnerable population.


  • NIDDK Support