Zaidan Nadim, Jalloul Youssef, Goldfarb David S, Azar Hiba, El-Sayegh Suzanne
Department of Medicine, Northwell Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY, 10305, USA.
Division of Nephrology, NYU Langone Health and NYU Grossman School of Medicine and New York Harbor VA Healthcare System, New York, NY, USA.
J Nephrol. 2025 Mar;38(2):531-540. doi: 10.1007/s40620-024-02159-4. Epub 2024 Dec 1.
Identifying factors associated with uncomplicated and complicated opioid use is essential, especially with regard to safety concerns in impaired kidney function. Literature about opioid prescription and their potential complications in patients with different stages of chronic kidney disease (CKD) is scarce. This study describes opioid use and poisoning in hospitalized CKD patients.
The National Inpatient Database (NIS) was queried from 2016 to 2020 to identify which patients with known CKD stages were admitted with diagnoses of uncomplicated and complicated opioid use, and opioid poisoning. Patients with end-stage kidney disease receiving any form of renal replacement therapy were excluded. CKD1 served as a reference, and demographic and socio-economic characteristics were accounted for. Logistic regressions were performed to evaluate the relationship between CKD stages and each condition.
The final cohort included 2,917,404 (14,587,017 weighted) CKD patients, of whom 1.763 ± 0.023% and 1.177 ± 0.016% had uncomplicated and complicated opioid use, respectively. Odds of uncomplicated use were lower with more advanced CKD stages. We observed an increase of complicated use with milder forms of CKD. No differences in odds of complicated opioid use were found when CKD4-5 patients were compared to CKD1. After adjustment, opioid use was found to be the main predictor of poisoning in hospitalized CKD patients.
Prescribers appear to be more cautious in patients with advanced CKD, with lower odds of being on opioid analgesics in this group. Most CKD patients had higher odds of complicated use, and poisoning was essentially driven by complicated opioid use rather than CKD stage.
确定与单纯性和复杂性阿片类药物使用相关的因素至关重要，尤其是考虑到肾功能受损时的安全问题。关于不同阶段慢性肾脏病（CKD）患者阿片类药物处方及其潜在并发症的文献很少。本研究描述了住院CKD患者的阿片类药物使用和中毒情况。
查询2016年至2020年的国家住院患者数据库（NIS），以确定哪些已知CKD阶段的患者因单纯性和复杂性阿片类药物使用及阿片类药物中毒的诊断而入院。接受任何形式肾脏替代治疗的终末期肾病患者被排除。以CKD1作为对照，并考虑了人口统计学和社会经济特征。进行逻辑回归以评估CKD阶段与每种情况之间的关系。
最终队列包括2917404名（加权后为14587017名）CKD患者，其中分别有1.763±0.023%和1.177±0.016%的患者有单纯性和复杂性阿片类药物使用情况。CKD阶段越 advanced，单纯性使用的几率越低。我们观察到，CKD病情较轻时，复杂性使用情况增加。将CKD4 - 5期患者与CKD1期患者进行比较时，复杂性阿片类药物使用的几率没有差异。调整后，发现阿片类药物使用是住院CKD患者中毒的主要预测因素。
对于晚期CKD患者，开处方者似乎更为谨慎，该组患者使用阿片类镇痛药的几率较低。大多数CKD患者复杂性使用的几率较高，中毒主要是由复杂性阿片类药物使用而非CKD阶段引起的。
