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Opioid use patterns and persistent use after hemodialysis access surgery.

Timothy P Copeland1, William J Nahm2, Karen Woo3

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|June 7, 2025
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Summary

Opioid prescriptions for hemodialysis access surgery increase the risk of long-term opioid use. Prescribing more than 42 tablets of 5-mg hydrocodone equivalents significantly elevates this risk, while shorter prescriptions do not.

Keywords:
Arteriovenous fistulaArteriovenous graftEnd-stage kidney diseaseHemodialysis accessMedicareOpioid prescribingPain managementPersistent opioid useSurgeon variabilityVascular access

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Area of Science:

  • Nephrology
  • Pain Management
  • Pharmacology

Background:

  • Opioid pain management is common after hemodialysis access creation.
  • The long-term consequences of these prescriptions are not well understood.

Purpose of the Study:

  • To evaluate the risk of persistent opioid use after hemodialysis access surgery.
  • To identify patterns in opioid dosage and duration associated with persistent use.

Main Methods:

  • Retrospective cohort study of Medicare-enrolled, opioid-naïve patients undergoing hemodialysis access creation.
  • Defined persistent opioid use as prescriptions 90 to 180 days post-surgery.
  • Used Cox proportional hazards and mixed-effect regression models to analyze opioid use patterns and risks.

Main Results:

  • Over 28,000 patients were included; 50.2% received an opioid prescription at access creation.
  • Prescriptions of ≥42 tablets (2 weeks) of 5-mg hydrocodone equivalents increased persistent opioid use risk by 1.28 times.
  • Prescriptions of ≤20 tablets were not associated with increased persistent opioid use risk.

Conclusions:

  • Hemodialysis access procedures pose a risk for persistent opioid use.
  • Conservative pain management guidelines for hemodialysis access are recommended.