Opioid Use Patterns and Persistent Use after Hemodialysis Access Surgery.

Objectives: Evaluate 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 United States 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 post-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 milligrams (5 mg) hydrocodone equivalents.

Results: A total of 28,404 patients (median age, 72 [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 3,289 (23.1%) opioid prescriptions for ≥42 tablets of 5 mg hydrocodone equivalents (i.e., ≥2 weeks prescription). Patients receiving 42 or more tablets of 5 mg hydrocodone equivalents (≥2 weeks) had 1.28 times the risk of persistent opioid use (95% CI 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 (HR 1.00, 95% CI 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.