Opioid prescribing practices in chronic kidney disease: a population-based cohort study
Molnar AO, Bota SE, Naylor K, Nash DM, Smith G, Suri RS, Sood MM, Gomes T, Garg AX. Nephrol Dial Transplant. 2021; Dec 9 [Epub ahead of print]. DOI: https://doi.org/10.1093/ndt/gfab343
Background — Chronic pain is common and management is complex in patients with chronic kidney disease (CKD), but limited data are available on opioid prescribing. We examined opioid prescribing for non-cancer, non-end-of-life-care in patients with CKD.
Methods — Population-based retrospective cohort study using administrative databases in Ontario, Canada that included adults with CKD defined by an eGFR <60 mL/min/1.73 m2 from November 1, 2012 to December 31, 2018 and estimated the proportion with opioid prescriptions (type, duration, dose, potentially inappropriate prescribing) within 1 year of cohort entry. Prescriptions had to precede dialysis, kidney transplant, or death.
Results — We included 680,445 adults with CKD, and 198,063 (29.1%) were prescribed opioids. Codeine (14.9%) and hydromorphone (7.2%) were most common. Among opioid users, 24.3% had repeated or long-term use, 26.1% were prescribed high doses, and 56.8% were new users. Opioid users were more likely to be female, have cardiac disease or a mental health diagnosis, and had more healthcare visits. The proportions for potentially inappropriate prescribing indicators varied (e.g. 50.1% with eGFR <30 were prescribed codeine, and 20.6% of opioid users were concurrently prescribed benzodiazepines, while 7.2% with eGFR<30 were prescribed morphine, and 7.0% received >1 opioid concurrently). Opioid prescriptions declined with time (2014: 31.6% vs. 2018: 26.3%, p<0.001), as did indicators of potentially inappropriate prescribing.
Conclusions — Opioid use was common in patients with CKD. While opioid prescriptions and potentially inappropriate prescribing have declined in recent years, interventions to improve pain management without the use of opioids and education on safer prescribing practices are needed.