Opioid Prescriptions for US Patients Undergoing Long-Term Dialysis or with Kidney Transplant from 2011 to 2020

Key Points The rate of prescription of opioid medication decreased between 2011 and 2020 for patients with ESRD. The risk of death for dialysis and kidney transplant patients increased as morphine milligram equivalents in prescriptions increased. Background Pain is important for patients with kidney failure, but opioid medication prescriptions are associated with morbidity and mortality. The Centers for Disease Control and Prevention issued opioid prescription guidelines in 2016 and 2022, associated with dramatically decreased prescription rates in the United States. It is critical to know whether nationwide opioid prescription rates for patients with kidney failure have decreased. Methods We analyzed the United States Renal Data System database from 2011 to 2020 to describe trends in the proportion of patients with ESKD who received one or more, or long-term, opioid prescriptions, examined factors associated with long-term opioid prescriptions, and evaluated associations of all-cause death with short-term or long-term opioid prescriptions. Results From 2011 to 2022, the percentage of patients with kidney failure (dialysis and kidney transplant) who received at least one or more, or who had received long-term, opioid medication prescriptions decreased steadily, from 60% to 42%, and from 23% to 13%, respectively (both P for trend < 0.001). The largest reductions in prescription rates were for hydrocodone and oxycodone. Similar trends existed for dialysis and kidney transplant patients. Women, the poor, and those in rural settings were more likely to receive long-term opioid prescriptions. Prescription rates were highest in White patients and those aged 45–64 years. Short-term and long-term opioid medication prescriptions were associated with higher mortality in both dialysis and kidney transplant patients. Conclusions The opioid prescription rates of patients with ESKD decreased between 2011 and 2020. Higher mortality risk was associated with both short-term and long-term opioid prescriptions. Mortality risk was monotonically associated with morphine milligram equivalents in patients with kidney failure who received long-term opioid prescriptions.