TY - JOUR
T1 - Benzodiazepines, codispensed opioids, and mortality among patients initiating long-term in-center hemodialysis
AU - Muzaale, Abimereki D.
AU - Daubresse, Matthew
AU - Bae, Sunjae
AU - Chu, Nadia M.
AU - Lentine, Krista L.
AU - Segev, Dorry L.
AU - McAdams-Demarco, Mara
N1 - Funding Information:
Funding for this study was provided in part by National Institute of Diabetes and Digestive and Kidney Diseases grants R01DK120518 (principal investigator [PI]: Dr. McAdams-DeMarco) and K24DK101828 (PI: Dr. Segev), and National Institute on Aging grant R01AG055781 (PI: Dr. McAdams-DeMarco).The data reported here have been supplied by the US Renal Data System. The interpretation and reporting of these data are the re-sponsibility of the author(s) and in no way should be seen as an official policy or interpretation of the US Government. All data can be publicly obtained. Dr. McAdams-DeMarco, Dr. Muzaale, and Dr. Segev designed the study; Dr. Muzaale analyzed the data; Dr. Bae, Dr. Chu, Dr. Daubresse, Dr. Lentine, Dr. McAdams-DeMarco, Dr. Muzaale, and Dr. Segev drafted and revised the manuscript; and Dr. Bae, Dr. Chu, Dr. Daubresse, Dr. Lentine, Dr. McAdams-DeMarco, Dr. Muzaale, and Dr. Segev (1) made substantial contribution to conception and design of the work, to data acquisition, to data analysis, or to data interpretation; (2) drafted or revised the manuscript for important intellectual content; (3) approved the final version of the manuscript; and (4) agree to be personally accountable for the individual’s own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are ap-propriately investigated and resolved, including with documenta-tion in the literature if appropriate.
Publisher Copyright:
© 2020 by the American Society of Nephrology.
PY - 2020/6/8
Y1 - 2020/6/8
N2 - Background and objectives Mortality from benzodiazepine/opioid interactions is a growing concern in light of the opioid epidemic. Patients on hemodialysis suffer from a high burden of physical/psychiatric conditions, which are treated with benzodiazepines, and they are three times more likely to be prescribed opioids than the general population. Therefore, we studied mortality risk associated with short-and long-acting benzodiazepines and their interaction with opioids among adults initiating hemodialysis. Design, setting, participants, & measurements The cohort of 69,368 adults initiating hemodialysis (January 2013 to December 2014) was assembled by linking US Renal Data System records to Medicare claims. Medicare claims were used to identify dispensed benzodiazepines and opioids. Using adjusted Cox proportional hazards models, we estimated the mortality risk associated with benzodiazepines (time varying) and tested whether the benzodiazepine-related mortality risk differed by opioid codispensing. Results Within 1 year of hemodialysis initiation, 10,854 (16%) patients were dispensed a short-acting benzodiazepine, and 3262 (5%) patients were dispensed a long-acting benzodiazepine. Among those who were dispensed a benzodiazepine during follow-up, codispensing of opioids and short-acting benzodiazepines occurred among 3819 (26%) patients, and codispensing of opioids and long-acting benzodiazepines occurred among 1238 (8%) patients. Patients with an opioid prescription were more likely to be subsequently dispensed a short-acting benzodiazepine (adjusted hazard ratio, 1.66; 95% confidence interval, 1.59 to 1.74) or a long-acting benzodiazepine (adjusted hazard ratio, 1.11; 95% confidence interval, 1.03 to 1.20). Patients dispensed a short-acting benzodiazepine were at a 1.45-fold (95% confidence interval, 1.35 to 1.56) higher mortality risk compared with those without a short-acting benzodiazepine; among those with opioid codispensing, this risk was 1.90-fold (95% confidence interval, 1.65 to 2.18; Pinteraction,0.001). In contrast, long-acting benzodiazepine dispensing was inversely associated with mortality (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72 to 0.99) compared with no dispensing of long-acting benzodiazepine; there was no differential risk by opioid dispensing (Pinteraction50.72). Conclusions Codispensing of opioids and short-acting benzodiazepines is common among patients on dialysis, and it is associated with higher risk of death.
AB - Background and objectives Mortality from benzodiazepine/opioid interactions is a growing concern in light of the opioid epidemic. Patients on hemodialysis suffer from a high burden of physical/psychiatric conditions, which are treated with benzodiazepines, and they are three times more likely to be prescribed opioids than the general population. Therefore, we studied mortality risk associated with short-and long-acting benzodiazepines and their interaction with opioids among adults initiating hemodialysis. Design, setting, participants, & measurements The cohort of 69,368 adults initiating hemodialysis (January 2013 to December 2014) was assembled by linking US Renal Data System records to Medicare claims. Medicare claims were used to identify dispensed benzodiazepines and opioids. Using adjusted Cox proportional hazards models, we estimated the mortality risk associated with benzodiazepines (time varying) and tested whether the benzodiazepine-related mortality risk differed by opioid codispensing. Results Within 1 year of hemodialysis initiation, 10,854 (16%) patients were dispensed a short-acting benzodiazepine, and 3262 (5%) patients were dispensed a long-acting benzodiazepine. Among those who were dispensed a benzodiazepine during follow-up, codispensing of opioids and short-acting benzodiazepines occurred among 3819 (26%) patients, and codispensing of opioids and long-acting benzodiazepines occurred among 1238 (8%) patients. Patients with an opioid prescription were more likely to be subsequently dispensed a short-acting benzodiazepine (adjusted hazard ratio, 1.66; 95% confidence interval, 1.59 to 1.74) or a long-acting benzodiazepine (adjusted hazard ratio, 1.11; 95% confidence interval, 1.03 to 1.20). Patients dispensed a short-acting benzodiazepine were at a 1.45-fold (95% confidence interval, 1.35 to 1.56) higher mortality risk compared with those without a short-acting benzodiazepine; among those with opioid codispensing, this risk was 1.90-fold (95% confidence interval, 1.65 to 2.18; Pinteraction,0.001). In contrast, long-acting benzodiazepine dispensing was inversely associated with mortality (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72 to 0.99) compared with no dispensing of long-acting benzodiazepine; there was no differential risk by opioid dispensing (Pinteraction50.72). Conclusions Codispensing of opioids and short-acting benzodiazepines is common among patients on dialysis, and it is associated with higher risk of death.
UR - http://www.scopus.com/inward/record.url?scp=85086279878&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85086279878&partnerID=8YFLogxK
U2 - 10.2215/CJN.13341019
DO - 10.2215/CJN.13341019
M3 - Article
C2 - 32457228
AN - SCOPUS:85086279878
SN - 1555-9041
VL - 15
SP - 794
EP - 804
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 6
ER -