Opioids Associated with Higher Risk of Mortality in Patients with Kidney Disease and Chronic Pain

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PainRelief.com Interview with:
Satya Surbhi, PhD
Assistant Professor, Division of General Internal Medicine, Department of Medicine
and Center for Health System Improvement, College of Medicine
Director of Measurement and Reporting, Tennessee Population Health Consortium
University of Tennessee Health Science Center

PainRelief.com: What is the background for this study?

Response: Pain is highly prevalent among individuals with chronic kidney disease (CKD), in whom commonly utilized analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) are often contraindicated. Opioids can be an alternative means of analgesia in patients with CKD, but they are associated with numerous unwanted adverse effects and current efforts are aimed at curbing opioid use in general, which leaves patients with few choices for analgesia. Non-opioid non-NSAID analgesics (e.g., gabapentin, acetaminophen, antipyrine) represent potential alternative choices, but their long-term outcomes in CKD compared to opioids are unknown.    

The objectives of this study were to

1) compare the association of chronic opioid vs. non-opioid analgesics with end-stage kidney disease (ESKD) and all-cause mortality among patients with CKD and chronic pain and

2) to examine the heterogeneity of treatment effects on outcomes by factors including age, sex, race, smoking status, BMI, cancer, eGFR and UACR levels, benzodiazepine use, and opioid/non-opioid prescription year. 

PainRelief.com: What are the main findings?

Response:   The study found that the use of opioid analgesics was significantly associated with higher risk of mortality among patients with CKD and chronic pain. The use of opioid analgesics was associated with higher risk of mortality among patients who were overweight or obese, with cancer, or UACR <30 mg/gm. Additionally, opioid use (vs. non-opioid use) was associated with a higher risk of mortality in patients who received prescriptions during 2015-2019, compared to those who received prescriptions during 2004-2014

PainRelief.com: What should readers take away from your report?

Response: The study findings suggest that non-opioid non-NSAID analgesics are safer medications for pain in comparison to opioids among patients with CKD and chronic pain.   

PainRelief.com: What recommendations do you have for future research as a result of this study?

Response Future studies should compare the effect of pharmacologic and non-pharmacologic treatment options on morbidity and mortality in patients with CKD and chronic pain.

Disclosures: This study was supported by grant I01HX002680 to Dr. Kovesdy and is the result of work supported with resources and the use of facilities at the Memphis VA Medical Center and the Long Beach VA Medical Center. Support for VA/CMS data is provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource Center. 

Citation: ASN 2023 abstract

  • Comparative Effectiveness of Opioids vs. Non-Opioid Analgesics on the Risk of ESRD and Mortality Among US Veterans with CKD and Chronic Pain
    Surbhi, Satya, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Mallisetty, Yamini, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Shrestha, Prabin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

https://www.asn-online.org/education/kidneyweek/2023/program-abstract.aspx?controlId=3942469

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Last Updated on November 2, 2023 by PainRelief.com