Opioid use and poisoning in hospitalized patients with chronic kidney disease

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.