Essays on Examining Unsafe Opioid Prescribing Measures Among End Stage Kidney Disease Patients
Open Access DepositedAmong HD patients, 13.6% experienced chronic use, 8.3% experienced daily MME ≥ 50, and 6.9% experienced concomitant use. Overall 19.4% of HD patients experienced at least one measure of UOP. This study found that patients had increased odds of experiencing at least one UOP if they were white, lived in a rural area, and had a higher Charlson comorbidity score. Conclusion
1) What is the proportion of UOP in the ESKD population that is receiving peritoneal dialysis. 2) What sociodemographic and clinical outcomes are associated with the increased odds of receiving unsafe levels of opioids. Data
Peritoneal dialysis (PD) patients are susceptible to unsafe opioid prescribing (UOP). Two studies found that compared to HD patients, PD patients are at an increased risk of death if they experienced chronic use of opioids. No other studies have examined measures of UOP in the PD population. Without additional research, it is unclear to what degree PD patients are experiencing measures of UOP. Objectives
Proportions were estimated for all major outcomes. Major outcomes are chronic use, daily MME ≥ 50, concomitant use of opioids and benzodiazepines, and having at least one of these measures of UOP. Bivariate and multivariate analyses were then conducted to assess associations between patient characteristics and measures of UOP. Results
This study addresses the following
Measuring Unsafe Opioid Prescribing for pain among ESKD patients receiving peritoneal dialysis during 2020Background
Compared to previous estimates of UOP measures, there was a decrease in 2020. Additionally, being dual eligible in Medicare and Medicaid was strongly associated with all measures of UOP. Policy suggestions were made regarding cost and access to alternative treatment strategies to decrease UOP. Additional research is needed on the efficacy of these treatments so that coverage can be increased to include patients with ESKD. Essay III
2) What sociodemographic and clinical outcomes are associated with the trends of UOP. Data
Opioid use in the hemodialysis (HD) population is reported to be greater than the general population. However, opioids are problematic in this population due to their association with adverse outcomes including death. In 2019, new practitioner-level measures for opioid safety in the end stage kidney disease (ESKD) population were used to estimate unsafe opioid prescribing (UOP) and a large proportion of HD patients experienced UOP. Since this study, no other research has examined the prevalence of UOP using the measures proposed.Objectives
The introduction of the CDC guideline is strongly associated with a decrease in UOP in HD and PD patients who had at least one year of treatment overlap with Medicare Part A, B, and D coverage. Suggestions were made on developing a trustworthy guideline for opioid prescribing based on future clinical studies and existing evidence to better inform ESKD providers and their patients.
The GEE model found that individuals had increased odds of experiencing at least one measure of UOP if a patient was white, lived in a rural area, had a higher Charlson comorbidity score, and received HD. The GEE model including linear splines found that there was a statistically significant association between the implementation of CDC guideline and a decrease in UOP. Conclusion
Essay I
Proportions were estimated for all major outcomes. Major outcomes are chronic use, daily MME ≥ 50, concomitant use of opioids and benzodiazepines, and having at least one of these measures of UOP. Bivariate analyses were then conducted to assess associations between characteristics and measures of UOP. Results
In 2016 the CDC implemented their opioid prescribing guideline. ESKD patients are one population that has high pain prevalence, but are not exempt from these guidelines. Because literature on trends of UOP in the ESKD population is limited, UOP measures should be estimated to assess the effects of the guideline on the ESKD population. Objectives
1) How has UOP trends changed in response to national guidelines related to opioid prescribing among ESKD patients receiving hemodialysis or peritoneal dialysis
This study used the United States Renal Data System data from 2013-2020. The database consists of data derived from CMS required forms including patient sociodemographics, clinical data, and Medicare Claims data. The population included in this study were any ESKD patients who received hemodialysis and peritoneal dialysis and had at least one year of treatment overlap with Medicare Part A, B, and D coverage. Methods
Compared to previous estimates of UOP measures, there was a decrease in 2020. Additionally, having an anxiety diagnosis was strongly associated with each measure of UOP. One potential intervention is implementing anxiety screening in the Medicare Quality Incentive Program. These interventions would improve patient access for treatments and could reduce UOP. Essay II
1) What is the proportion of UOP in the ESKD population that is receiving HD. 2) What sociodemographic and clinical outcomes are associated with the increased odds of receiving unsafe levels of opioids Data
Examining the impact of opioid guidelines on unsafe opioid prescribing trends among ESKD patients receiving in-center hemodialysis and peritoneal dialysis from 2013-2020Background
This study used the United States Renal Data System data for 2020. The database consists of data derived from Centers for Medicare and Medicaid (CMS) including patient sociodemographics, clinical, and Medicare Claims data. The population included in this study were ESKD patients who received PD for at least 9 months of the year and their treatment overlapped with Medicare Part A, B, and D coverage. Methods
Trends in the proportion of UOP measures were examined over time. Outcome measures included chronic use, daily MME ≥ 50, concomitant use of opioids and benzodiazepines, and having at least one UOP measure. Several Generalized Estimating Equation (GEE) models were performed to identify if patient characteristics were associated with at least one UOP measure and if changes occurred after certain interventions. Results
Measuring unsafe opioid prescribing for pain among end stage kidney disease patients receiving in-center hemodialysis during 2020 Background
Among PD patients, 9.1% experienced chronic use, 6.5% experienced daily MME ≥ 50, and 5.8% experienced concomitant use. Overall 15.1% of PD Patients experienced at least one measure of UOP. This study found that patients had increased odds of experiencing UOP if they were white, lived in a rural area, and had a higher Charlson comorbidity score. Conclusion
This study used the United States Renal Data System data for 2020. The database consists of data derived from Centers for Medicare and Medicaid (CMS) including patient sociodemographics, clinical, and Medicare Claims data. The population included in this study were ESKD patients who received HD for at least 9 months of the year and their treatment overlapped with Medicare Part A, B, and D coverage. Methods
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