An analysis in the Clinical Journal of the American Society of Nephrology indicates that despite current recommendations, opioid pain medications may not be safe for patients undergoing haemodialysis.
Individuals with kidney failure undergoing haemodialysis may be especially vulnerable to opioid-related complications due to factors such as their kidneys’ reduced ability to clear drugs from the body.
To evaluate the risks of opioid use in patients undergoing haemodialysis, Julie Ishida, MD, University of California at San Francisco, San Francisco, California, and colleagues examined information from 140,899 adults covered by Medicare in the United States who were receiving in-centre haemodialysis in 2011.
Risk was evaluated according to average daily opioid dose (>60 mg, ≤60 mg, and per 60 mg dose increment). Of the patients, 64% received opioids and 17% experienced an episode of altered mental status, fall, or fracture requiring an emergency room visit or hospitalisation.
Opioid use was associated with higher risks for altered mental status (28% to 67% increased risk), fall (4% to 45% increased risk), and fracture in a dose-dependent manner (4% to 65% increased risk).
These risks were present even when patients were not prescribed high doses and when they received opioid medications that are recommended for use in patients undergoing haemodialysis.
“Opioid use in patients receiving haemodialysis, even at lower dosing, is not without risk,” said Dr. Ishida. “The balance of risks and benefits in this population should be carefully considered.”
“Future research and strategies to predict and reduce the risks of opioid use in patients receiving haemodialysis are needed,” she added.