Opioid use patterns and persistent use after hemodialysis access surgery.

OBJECTIVE: We evaluated the risk of persistent opioid use related to opioid pain management for hemodialysis access creation and identify patterns of opioid dosage and use.

METHODS: This retrospective cohort study included Medicare-enrolled opioid-naïve patients in the US Renal Data System who initiated hemodialysis for end-stage kidney disease between April 2015 and June 2019. Persistent opioid use was defined as an opioid prescription 90 to 180 days after surgery. The Cox proportional hazards model used censored patients at the time of hospitalization, subsequent hemodialysis access procedures, death, and end of Medicare enrollment. A mixed-effect logistic regression modeled opioid prescription, and a mixed-effect linear regression modeled opioid quantity in 5-mg hydrocodone equivalents.

RESULTS: A total of 28,404 patients (median age, 72 years; 25th, 75th percentile, 66, 79 years; 15,322 men [53.9%]) underwent index access creation, of whom 14,265 patients filled an opioid prescription at access creation (50.2%), with 3289 opioid prescriptions (23.1%) for ≥42 tablets of 5-mg hydrocodone equivalents (ie, ≥2 weeks prescription). Patients receiving ≥42 tablets of 5-mg hydrocodone equivalents (≥2 weeks) had 1.28 times the risk of persistent opioid use (95% confidence interval, 1.08-1.52) relative to those who did not fill an opioid prescription. In contrast, receipt of 20 or fewer tablets of 5-mg hydrocodone equivalents was not associated with an increased risk of persistent opioid use (hazard ratio 1.00; 95% confidence interval, 0.85-1.18).

CONCLUSIONS: Given the risk of persistent opioid use stemming from hemodialysis access procedures, the development of formal recommendations for conservative hemodialysis access pain management may be worth considering.