Leja Noah, Genord Cheryl K, Berriman Sarah M, Ellis Jessica J
University of Michigan Health System, Ann Arbor, MI, USA.
Saint Joseph Mercy Hospital, Ann Arbor, MI, USA.
Hosp Pharm. 2022 Feb;57(1):101-106. doi: 10.1177/0018578720985427. Epub 2020 Dec 29.
The objectives of this study were (1) to assess the impact of the 2016 Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain (GPOCP) on tramadol and opioid prescription rates in patients with chronic kidney disease (CKD), (2) to identify if tramadol was being properly dosed based on kidney function, and (3) to identify the number of clinically relevant drug-drug interactions related to tramadol. Retrospective cohort study. Patients with a diagnosis of CKD stage IV or V or end-stage renal disease (ESRD) with a hospital discharge were identified. Participants were distributed into a pre-GPOCP cohort (January to December 2015) and post-GPOCP cohort (January 2017 to May 31, 2018) based on their hospital discharge date. Participants were then further divided into three categories: those who were discharged with a new prescription for tramadol, those who were discharged with a prescription for another opioid product, or those who were discharged with no new opioid or tramadol prescription. The primary outcome was incidence of new outpatient tramadol and opioid hospital discharge prescriptions. The secondary outcomes were the number of correctly dosed tramadol discharge prescriptions based on kidney function and incidence of clinically significant drug-drug interactions with tramadol. New tramadol and opioid prescription rates upon hospital discharge for CKD stage IV and V and ESRD patients decreased from 76 (2.5%) to 54 (1.1%) and from 145 (4.7%) to 119 (2.5%), respectively ( < .001). Among the patients discharged with a new tramadol prescription, 113 (86.9%) patients did not have any clinically significant drug-drug interactions, and 94 (72.3%) patients were dosed correctly based on kidney function. The incidence of new outpatient tramadol and opioid prescriptions at discharge was significantly lower after the CDC GPOCP publication than before the publication.
（1）评估2016年美国疾病控制与预防中心（CDC）慢性疼痛阿片类药物处方指南（GPOCP）对慢性肾脏病（CKD）患者曲马多和阿片类药物处方率的影响；（2）确定曲马多的剂量是否根据肾功能进行了合理调整；（3）确定与曲马多相关的具有临床意义的药物相互作用的数量。回顾性队列研究。确定诊断为CKD IV期或V期或终末期肾病（ESRD）且已出院的患者。根据出院日期，将参与者分为GPOCP发布前队列（2015年1月至12月）和GPOCP发布后队列（2017年1月至2018年5月31日）。然后将参与者进一步分为三类：出院时开具曲马多新处方的患者、出院时开具其他阿片类产品处方的患者，或出院时未开具新的阿片类药物或曲马多处方的患者。主要结局是新的门诊曲马多和阿片类药物出院处方的发生率。次要结局是根据肾功能正确调整剂量的曲马多出院处方数量以及与曲马多发生的具有临床意义的药物相互作用的发生率。CKD IV期和V期以及ESRD患者出院时新的曲马多和阿片类药物处方率分别从76（2.5%）降至54（1.1%），从145（4.7%）降至119（2.5%）（P<0.001）。在出院时开具曲马多新处方的患者中，113例（86.9%）患者没有任何具有临床意义的药物相互作用，94例（72.3%）患者的剂量根据肾功能进行了正确调整。CDC GPOCP发布后，出院时新的门诊曲马多和阿片类药物处方的发生率显著低于发布前。
