Opioids Tied to Adverse Outcomes in Hemodialysis Patients
Increased risks of altered mental status, falls, and fractures; risk present even at low doses of opioids
THURSDAY, April 19, 2018 (HealthDay News) -- For patients on hemodialysis, opioids are associated with adverse outcomes, according to a study published online April 19 in the Clinical Journal of the American Society of Nephrology.
Julie H. Ishida, M.D., from the University of California in San Francisco, and colleagues conducted a cohort study to examine the correlation between opioid use and time to first emergency room visit or hospitalization for altered mental status, fall, or fracture among 140,899 Medicare-covered adults receiving hemodialysis in 2011. Risks were assessed according to average daily total opioid dose and specific agents.
The researchers found that 64 percent of patients received opioids and 17 percent had an episode of altered mental status, fall, or fracture. There was a correlation for opioid use with risk for all outcomes in a dose-dependent manner: altered mental status (hazard ratios, 1.28 and 1.67 for lower and higher dose, respectively; 1.29 per 60 mg), fall (hazard ratios, 1.28 and 1.45 for lower and higher dose, respectively; 1.04 per 60 mg), and fracture (hazard ratios, 1.44 and 1.65 for lower and higher dose, respectively; 1.04 per 60 mg). The risk of altered mental status was significantly higher with all agents, while several agents correlated with increased risk of fall and fracture.
"Opioids were associated with adverse outcomes in patients on hemodialysis, and this risk was present even at lower dosing and for agents that guidelines have recommended for use," the authors write.