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eGFR Affects Risk for Opioid-Related Death, Hospitalization

FRIDAY, Oct. 4, 2019 -- Receipt of prescription opioids is associated with an increased risk for death and hospitalization, especially in patients with lower estimated glomerular filtration rates (eGFRs), according to a study published online Oct. 3 in the Clinical Journal of the American Society of Nephrology.

Tessa K. Novick, M.D., from the Johns Hopkins University Bloomberg School of Public Health in Baltimore, and colleagues examined opioid-associated risks for death and hospitalization across the range of eGFRs. Patients receiving their first opioid prescription were propensity-matched to those receiving nonsteroidal anti-inflammatory drugs (NSAIDs; cohort, 46,246 patients).

The researchers found that when evaluated at eGFR 80 mL/min/1.73 m², prescription of 1 to 59 daily oral morphine milligram equivalents (MMEs) and ≥60 MMEs correlated with an increased risk for death (hazard ratios, 1.70 and 2.25, respectively) and hospitalization (hazard ratios, 1.38 and 1.68, respectively) compared with NSAID prescriptions. At lower eGFRs, the relative risk for death associated with ≥60 MMEs was higher (e.g., eGFR 40 mL/min/1.73 m²: hazard ratio, 3.94). Compared with gabapentinoids, only ≥60 MMEs correlated with a significantly increased risk for death (hazard ratio, 2.72), while both 1 to 59 and ≥60 MMEs correlated with a significantly elevated risk for hospitalization (hazard ratio, 1.2 and 1.54, respectively).

"For patients with reduced eGFR and opioid prescriptions, counseling about the possible risks associated with opioids, promotion of nonpharmacologic therapies, and regular consideration of whether the benefit of pain control outweighs such risks is crucial," the authors write.

One author disclosed financial ties to the health information technology and health care consultancy industries.

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Posted: October 2019

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