Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York.
Clin J Am Soc Nephrol. 2023 Jan 1;18(1):91-98. doi: 10.2215/CJN.0000000000000019.
Gabapentinoids, commonly used for treating neuropathic pain, may be misused and coprescribed with opioid and benzodiazepine, increasing the risk of mortality and dependency among kidney transplant recipients.
We identified adult kidney transplant recipients who enrolled in Medicare Part D in 2006-2017 using the United States Renal Data System/Medicare claims database. We characterized recipients' post-transplant concomitant prescription of gabapentinoids, opioids, and benzodiazepine stratified by transplant year and recipient factors (age, sex, race, and diabetes). We investigated whether concomitant prescriptions were associated with postkidney transplant mortality using Cox regression. Models incorporated inverse probability weighting to adjust for confounders.
Among 63,359 eligible recipients, 13% of recipients filled at least one gabapentinoid prescription within 1 year after kidney transplant. The prevalence of gabapentinoid prescriptions increased by 70% over the study period (16% in 2017 versus 10% in 2006). Compared with nonusers, gabapentinoids users were more likely to have diabetes (55% versus 37%) and obesity (46% versus 34%). Of the 8509 recipients with gabapentinoid prescriptions, 45% were coprescribed opioids, 7% were coprescribed benzodiazepines, and 3% were coprescribed both opioids and benzodiazepines. Compared with no study prescriptions, gabapentinoid monotherapy (adjusted hazard ratio [aHR]=1.25; 95% confidence interval [CI], 1.16 to 1.32) and combination therapy (gabapentinoids and opioids [aHR=1.49; 95% CI, 1.39 to 1.60], gabapentinoids and benzodiazepines [aHR=1.46; 95% CI, 1.03 to 2.08], and coprescribing all three [aHR=1.88; 95% CI, 1.18 to 2.98]) were all associated with a higher risk of postkidney transplant mortality.
Gabapentinoid coprescription with both benzodiazepines and opioids among kidney transplant recipients increased over time. Kidney transplant recipients prescribed gabapentinoids had a higher risk of post-transplant mortality, and the risk was higher with opioids or benzodiazepine coprescription.
加巴喷丁类药物常用于治疗神经性疼痛，但可能被滥用，并与阿片类药物和苯二氮䓬类药物同时开处方，这会增加肾移植受者的死亡率和依赖风险。
我们使用美国肾脏数据系统/医疗保险索赔数据库，确定了 2006 年至 2017 年参加医疗保险 D 部分的成年肾移植受者。我们根据移植年份和受者因素（年龄、性别、种族和糖尿病），对接受者在移植后同时开具加巴喷丁类药物、阿片类药物和苯二氮䓬类药物的情况进行了描述。我们使用 Cox 回归调查了同时开具处方是否与肾移植后死亡相关。模型采用逆概率加权法来调整混杂因素。
在 63359 名合格的受者中，13%的受者在肾移植后 1 年内至少开了一种加巴喷丁类药物处方。在研究期间，加巴喷丁类药物处方的比例增加了 70%（2017 年为 16%，而 2006 年为 10%）。与未使用者相比，加巴喷丁类药物使用者更有可能患有糖尿病（55%比 37%）和肥胖症（46%比 34%）。在 8509 名有加巴喷丁类药物处方的受者中，45%同时开了阿片类药物，7%同时开了苯二氮䓬类药物，3%同时开了阿片类药物和苯二氮䓬类药物。与无研究处方相比，加巴喷丁类药物单药治疗（调整后的危害比[aHR]=1.25；95%置信区间[CI]，1.16 至 1.32）和联合治疗（加巴喷丁类药物和阿片类药物[aHR=1.49；95% CI，1.39 至 1.60]，加巴喷丁类药物和苯二氮䓬类药物[aHR=1.46；95% CI，1.03 至 2.08]，同时开三种药物[aHR=1.88；95% CI，1.18 至 2.98]）均与肾移植后死亡率升高相关。
肾移植受者同时开具加巴喷丁类药物与苯二氮䓬类药物和阿片类药物的情况随着时间的推移而增加。开具加巴喷丁类药物的肾移植受者有更高的移植后死亡风险，而与阿片类药物或苯二氮䓬类药物同时开处方则风险更高。
