Opioid Prescription, Morbidity, and Mortality in United States Dialysis Patients
Opioid Prescription, Morbidity, and Mortality in United States Dialysis Patients
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DOI：
10.1681/asn.2017010098
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发表时间：
2017-12-01
影响因子：
13.6
通讯作者：
Eggers, Paul W.
中科院分区：
文献类型：
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作者：
Kimmel, Paul L.;Fwu, Chyng-Wen;Eggers, Paul W.
对ESRD患者提倡积极的疼痛治疗，但新的疾病控制和预防中心指南建议谨慎的阿片类药物处方。关于与ESRD阿片类药物处方相关的结局知之甚少。我们使用2006-2010年美国肾脏数据系统信息，在每个研究年（n= 671，281，其中271，285例为独特患者）中评估了阿片类药物处方以及阿片类药物处方和剂量与患者结局之间的相关性，这些患者接受了维持透析，且医疗保险A、B和D部分覆盖。根据D部分处方声明确认了阿片类处方。在2010年的流行队列（n= 153，758）中，我们检查了阿片类药物处方与随后的全因死亡、透析中止和住院的相关性，并对人口统计学、合并症、方式和居住地进行了控制。总体而言，>60%的透析患者每年至少有一次阿片类药物处方。每年约有20%的患者接受长期（>= 90天供应）阿片类药物处方，2010年通常为氢可酮、羟考酮或曲马多。在2010年队列中，与未使用阿片类药物处方的患者相比，短期（1-89天）和长期阿片类药物处方的患者死亡率、透析中止和住院率增加。所有阿片类药物均与死亡率相关;大多数与发病率恶化相关。较高的阿片类药物剂量与死亡呈单调递增的方式相关。我们得出结论，阿片类药物处方与透析患者死亡、透析中止和住院的风险增加相关。无法推断因果关系，阿片类药物处方可能是一种疾病标志物。努力有效地治疗透析患者的疼痛，同时减少阿片类药物处方和剂量值得考虑。
Aggressive pain treatment was advocated for ESRD patients, but new Centers for Disease Control and Prevention guidelines recommend cautious opioid prescription. Little is known regarding outcomes associated with ESRD opioid prescription. We assessed opioid prescriptions and associations 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). Opioid prescription was confirmed from Part D prescription claims. In the 2010 prevalent cohort (n=153,758), we examined associations of opioid prescription with subsequent all-cause death, dialysis discontinuation, and hospitalization controlled for demographics, comorbidity, modality, and residence. Overall, >60% of dialysis patients had at least one opioid prescription every year. Approximately 20% of patients had a chronic (>= 90-day supply) opioid prescription each year, in 2010 usually for hydrocodone, oxycodone, or tramadol. In the 2010 cohort, compared with patients without an opioid prescription, patients with short-term(1-89 days) and chronic opioid prescriptions had increased mortality, dialysis discontinuation, and hospitalization. All opioid drugs associated with mortality; most associated with worsened morbidity. Higher opioid doses correlated with death in a monotonically increasing fashion. We conclude that opioid drug prescription is associated with increased risk of death, dialysis discontinuation, and hospitalization in dialysis patients. Causal relationships cannot be inferred, and opioid prescription may be an illness marker. Efforts to treat pain effectively in patients on dialysis yet decrease opioid prescriptions and dose deserve consideration.