Kimmel PL, et al. - This study used 2006–2010 US Renal Data System information to evaluate opioid prescriptions and associations between opioid prescription and dose and patient outcomes in patients on maintenance dialysis with Medicare Part A, B, and D coverage in each study year. In dialysis patients, an association was evident between opioid drug prescription and increased risk of death, dialysis discontinuation, and hospitalization. Researchers failed to conclude causal links but they observed that opioid prescription may be an illness marker. In addition, data reported that efforts to treat pain effectively in patients on dialysis yet decrease opioid prescriptions and dose deserve consideration.

Methods

• Researchers evaluated opioid prescriptions and links between opioid prescription and dose and patient outcomes using 2006–2010 US Renal Data System information in patients on maintenance dialysis with Medicare Part A, B, and D coverage in each study year (n=671,281, of whom 271,285 were unique patients).
• They confirmed opioid prescription from Part D prescription claims.
• In the 2010 prevalent cohort (n=153,758), they assessed associations of opioid prescription with subsequent all-cause death, dialysis discontinuation, and hospitalization controlled for demographics, comorbidity, modality, and residence.

Results

• Findings showed that, overall, >60% of dialysis patients had at least one opioid prescription every year.
• Researchers found that approximately 20% of patients had a chronic (≥90-day supply) opioid prescription each year, in 2010 usually for hydrocodone, oxycodone, or tramadol.
• They also noted that in the 2010 cohort versus patients without an opioid prescription, patients with short-term (1–89 days) and chronic opioid prescriptions had increased mortality, dialysis discontinuation, and hospitalization.
• Data reported that all opioid drugs associated with mortality; most associated with worsened morbidity.
• In addition, a correlation was reported between higher opioid doses and death in a monotonically increasing fashion.