|Title:||Frailty modifies the association between opioid use and mortality in chronic kidney disease patients with diabetes: a population-based cohort study||Authors:||SZU-YING LEE
on behalf of the COGENT study group (COhort of GEriatric Nephrology in NTUH)
|Issue Date:||2020||Publisher:||Impact Journals LLC||Journal Volume:||12||Journal Issue:||21||Start page/Pages:||21730-21746||Source:||Aging||Abstract:||
The prevalence of chronic pain in patients with chronic kidney disease (CKD) and diabetes mellitus is high and correlates with higher frailty risk, but satisfactory pain control frequently fails, necessitating opioid initiation. We aimed to examine whether opioid use affected their outcomes and whether such a relationship was modified by frailty. From the longitudinal cohort of diabetes patients (n = 840,000), we identified opioid users with CKD (n = 26,029) and propensity score-matched them to opioid-na?ve patients in a 1:1 ratio. We analyzed the associations between opioid use and long-term mortality according to baseline frailty status, defined by the modified FRAIL scale. Among all, 20.3% did not have any FRAIL items, while 57.2%, 20.6%, and 1.9% had 1, 2, and at least 3 positive FRAIL items, respectively. After 4.2 years, 16.4% died. Cox proportional hazard regression showed that opioid users exhibited an 18% higher mortality risk (HR 1.183, 95% CI 1.13-1.24) with a dose- and duration-responsive relationship, compared to opioid-naive ones. Furthermore, the mortality risk posed by opioids was observed only in CKD patients without frailty but not in those with frailty. In conclusion, opioid use increased mortality among patients with CKD, while this negative outcome influence was not observed among frail ones. ? 2020. Lee et al. All Rights Reserved.
|ISSN:||1945-4589||DOI:||10.18632/aging.103978||SDG/Keyword:||narcotic analgesic agent; aged; chronic kidney failure; chronic pain; cohort analysis; complication; diabetes mellitus; female; frailty; human; male; middle aged; mortality; Aged; Analgesics, Opioid; Chronic Pain; Cohort Studies; Diabetes Mellitus; Female; Frailty; Humans; Male; Middle Aged; Renal Insufficiency, Chronic
|Appears in Collections:||醫學系|
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